A case report of Listeria monocytogenes abscesses presenting as cortically predominant ring-enhancing lesions

Indira DeJesus-Alvelo, Amedeo Merenda

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Introduction:Listeria monocytogenes, a common cause of bacterial meningitis, rarely involves the central nervous system (CNS) in the form of multiple cerebral ring-enhancing lesions. Methods: An 81-year-old woman with rapidly progressive decline in her mental status in the setting of multiple cortically predominant ring-enhancing lesions was transferred to our institution. A mild upper respiratory tract infection and diarrhea symptoms preceded the mental status deterioration. Her past medical history is significant for type 2 diabetes mellitus. In light of the patient's age, the presence of hyponatremia and the history of diabetes mellitus, the empiric antimicrobial treatment was modified to include ampicillin, meropenem, vancomycin, voriconazole and pyrimethamine/sulfadiazine to prevent opportunistic infections. Intravenous dexamethasone was added due to significant perilesional vasogenic edema. Results: The patient presented with stupor, but neither fever nor leukocytosis. CSF results were significant only for a mildly elevated protein level. The report of a repeat brain MRI was as follows: large areas of high FLAIR signals and tubular/lobulated/ring enhacement in bifrontal regions with a smaller focus in the left anterior midbrain, indicating for underlying multicentric glioma or multicentric primary CNS lymphoma. A brain biopsy, however, revealed an early abscess formation caused by a L. monocytogenes infection. Conclusion: A high index of suspicion in patients with risk factors for this infection is key to ensure the timely initiation of appropriate empirical antibiotic therapy in the setting of cerebral ring-enhancing lesions. Intravenous ampicillin is the treatment of choice, but meropenem represents a valid alternative.

Original languageEnglish (US)
Pages (from-to)105-109
Number of pages5
JournalCase Reports in Neurology
Volume7
Issue number1
DOIs
StatePublished - May 22 2015

Fingerprint

meropenem
Listeria monocytogenes
Abscess
Ampicillin
Central Nervous System
Sulfadiazine
Stupor
Pyrimethamine
Listeriosis
Bacterial Meningitides
Hyponatremia
Leukocytosis
Opportunistic Infections
Brain
Vancomycin
Mesencephalon
Glioma
Respiratory Tract Infections
Type 2 Diabetes Mellitus
Dexamethasone

Keywords

  • Cerebral abscess
  • Cerebritis
  • Infections
  • Listeriosis
  • Neuroradiology

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

A case report of Listeria monocytogenes abscesses presenting as cortically predominant ring-enhancing lesions. / DeJesus-Alvelo, Indira; Merenda, Amedeo.

In: Case Reports in Neurology, Vol. 7, No. 1, 22.05.2015, p. 105-109.

Research output: Contribution to journalArticle

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