title: An unusual presentation of paediatric Listeria meningitis with selective spinal grey matter involvement and acute demyelinating polyneuropathy.
abstract: BACKGROUND
  Paediatric Listeria meningitis is rare, especially in immuno-competent children, but associated with significant mortality and morbidity and frequent complications.
  
  
  METHODS
  We report an unusual case of Listeria meningitis in a previously healthy 35 month-old girl with selective spinal grey matter involvement and demyelination in neurophysiological studies. Despite adequate antibiotic treatment, the case was initially complicated by ventriculitis, hydrocephalus and tonsillar herniation through the foramen magnum, requiring external ventricular drainage and subsequent ventriculoperitoneal shunt insertion. Paucity of movements, hypotonia, areflexia and bladder dysfunction then became evident.
  
  
  RESULTS
  Electromyogram and nerve conduction studies showed acute inflammatory demyelinating polyneuropathy and the patient received intravenous immunoglobulin followed by corticosteroids. MRI scans with contrast revealed extensive whole cord selective grey matter signal changes. She required extensive neurorehabilitation, making gradual (but incomplete) recovery.
  
  
  CONCLUSIONS
  Spinal cord involvement is rare in neuro-listeriosis and there no previous paediatric reports of Listeria-related myelitis or demyelinating polyneuropathy. The mechanism behind these presentations is unclear but an auto-immune response to the infection might be considered.
authors.affiliation: Genetics and Genomics Medicine Unit, UCL-Institute of Child Health, London, UK; Department of Neurology, Great Ormond Street Hospital, London, UK. Electronic address: apostolos.papandreou@ucl.ac.uk.
authors.forename: A
authors.initials: A
authors.lastname: Papandreou
authors.affiliation: Department of Neurology, Great Ormond Street Hospital, London, UK; Department of Paediatrics, Hospital Universitario Río Hortega, Valladolid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Hedrera-Fernandez
authors.affiliation: Department of Neurology, Great Ormond Street Hospital, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Kaliakatsos
authors.affiliation: Department of Neuroradiology, Great Ormond Street Hospital, London, UK.
authors.forename: W K
authors.initials: WK
authors.lastname: Chong
authors.affiliation: Department of Neurology, Great Ormond Street Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Bhate
mesh_terms: D002675:Child, Preschool; D005260:Female; D066128:Gray Matter / Q000473:pathology*; D020275:Guillain-Barre Syndrome / Q000382:microbiology / Q000473:pathology; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008584:Meningitis, Listeria / Q000150:complications / Q000473:pathology*; D013118:Spinal Cord Diseases / Q000382:microbiology* / Q000473:pathology*
keywords: Demyelination; Listeria monocytogenes; Meningitis; Paediatrics; Spinal cord involvement