[Rhombencephalitis due to Listeria monocytogenes].
A 37-year-old man presented with acute dizziness, nausea, headache and fever. Later on, he developed diplopia, swallowing difficulties, numbness and ataxia. MRI on day 6 showed hypo-intense, contrast-enhancing lesions on TI-weighted scans in the brainstem and cerebellum. Cerebrospinal fluid (CSF) findings on day 6 included pleiocytosis, a mildly-elevated protein level and mildly-decreased glucose level. CSF and blood cultures were initially negative for both bacteria and viruses. Acute disseminated encephalomyelitis (ADEM) was suspected and dexamethasone therapy was started. On day 26, a blood culture was positive for Listeria monocytogenes. The diagnosis 'Listeria rhombencephalitis' was made and the patient was treated with amoxicillin. This resulted in good recovery. In patients with a subacute onset of progressive cranial nerve dysfunction, ataxia, CSF pleiocytosis, and MRI lesions in the brainstem and cerebellum, Listeria rhombencephalitis should be considered. Early diagnosis and treatment improve the prognosis.
den Hertog
M H
MH
Erasmus MC-Centrum, Postbus 2040, 3000 CA Rotterdam. m.denhertog@erasmusmc.nl
Ang
C W
CW
Dippel
D W J
DW
D000328:Adult; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004660:Encephalitis / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008089:Listeria monocytogenes / Q000302:isolation & purification*; D008088:Listeriosis / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D011379:Prognosis; D012249:Rhombencephalon / Q000382:microbiology* / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000658:Amoxicillin