Listeria rhombencephalitis mimicking acute disseminated encephalomyelitis in a patient without predisposing medical cond
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CASE REPORT
Listeria rhombencephalitis mimicking acute disseminated encephalomyelitis in a patient without predisposing medical conditions Hongna Yang 1 & Cuilan Wang 2 & Hao Wang 1 & Shifang Ding 1 Received: 2 July 2020 / Revised: 24 July 2020 / Accepted: 14 August 2020 # Journal of NeuroVirology, Inc. 2020
Abstract Listeria rhombencephalitis (L. rhombencephalitis) is an uncommon form of central nervous system infection caused by Listeria monocytogenes (LM). It often occurs to immunocompetent individuals. Here, we described the case of a 45-year-old female patient without medical histories, who presented for high-grade fever, headache, and focal neurological manifestations. She was initially empirically diagnosed with acute disseminated encephalomyelitis (ADEM) because of clinical symptoms, acute clinical course, and neuroimaging. However, the biochemical analysis of cerebral spinal fluid (CSF) questioned the diagnosis of ADEM. The final diagnosis of L. rhombencephalitis was based on CSF culture for LM. Thus, L. rhombencephalitis should be preferentially and empirically considered for a patient with significantly elevated lactic acid and moderately increased red cells in CSF at early time, accompanied with rapidly progressive neurological dysfunctions involved in the brain stem. Keywords Listeria monocytogenes . Listeria rhombencephalitis . Acute disseminated encephalitis . Lactic acid . Cerebral spinal fluid
Introduction Listeria monocytogenes (LM) as a Gram-positive bacillus and facultative intracellular bacterium is considered to be the most common bacterial foodborne infections and transmitted through the consumption of contaminated food such as meat, vegetables, ready-to-eat seafood, unpasteurized milk, softserve ice creams, and soft cheese. LM infections most commonly affect the patients older than 60 or the first 30 days of life, pregnant women, and immunocompromised patients, who include hematologic malignancies, solid organ transplantation, diabetes, chronic renal failure, cirrhosis, alcoholism, human immunodeficiency virus (HIV) infection, history of corticosteroid use, chemotherapy, or monoclonal antibody
* Hongna Yang [email protected] 1
Department of Critical-care Medicine, Qilu Hospital of Shandong University, Shandong University, Shandong Province, Jinan 250012, China
2
Department of Neurology, Qilu Hospital of Shandong University, Shandong University, Shandong Province, Jinan 250012, China
use (Schlech 2019; Arslan et al. 2015). Here, we describe a case of listeria rhombencephalitis (L. rhombencephalitis) in a healthy adult with no predisposing factors and the history of unpasteurized dairy product consumption.
Case presentation A 45-year-old female patient without medical histories was admitted to our emergency department, who complained for high-grade fever, headache, nausea, and vomiting of 8-day duration. She suffered from left side limb weakness, dysarthria, and dysphagia 3 days before her admission to our hospital. On admission to our hospital, her GCS (Glasgow Coma Scale) was 14 (E4V4
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