Abstract
Introduction: Listeria monocytogenes is a facultative gram-positive bacterium transmitted mainly by contaminated food. Although neuroinfection by Listeria in immunocompetent patients is rare, it can be associated with a severe course and high lethality. Its most common presentation is the non-invasive gastrointestinal form; however, rhomboencephalitis with severe course can also occur. This clinical case is presented because of its atypical presentation in a patient without comorbidities and without risk factors associated with a fatal outcome.
Case Report: 49-year-old woman, with no pathological history, presented with headache, fever, gastrointestinal symptoms and progressive deterioration of the level of consciousness after consumption of possibly undercooked pork. She initially received empirical antibiotics without improvement. On admission to our institution, Listeria monocytogenes infection was confirmed by blood cultures and CSF molecular panel. Despite targeted treatment with ampicillin, gentamicin, rifampicin, colistin and finally meropenem, the patient developed rhomboencephalitis, ventriculitis, communicating hydrocephalus, non-reactive mydriasis, areactive and died of truncal ischemia and cardiorespiratory arrest.
Discussion: This case highlights the need to consider Listeria monocytogenes as an etiologic agent in immunocompetent patients with severe neuroinfection, especially in the presence of previous digestive symptoms or exposure to risky foods. Early recognition and specific treatment are determinant to improve neurological prognosis.
Conclusions: Listerial rhomboencephalitis in immunocompetent patients, although infrequent, can evolve rapidly with fatal outcome. Its timely diagnosis allows initiating a directed management that could avoid severe neurocritical complications.
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