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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Rapid detection of Listeria monocytogenes rhombencephalitis in an immunocompetent patient by multiplexed PCR
  1. Rocco J Richards1,
  2. Matthew S Simon2,
  3. C Douglas Phillips2,
  4. Lindsay Lief2,
  5. Stephen G Jenkins2,
  6. Michael S Satlin2,3
  1. 1Infectious Diseases Service/Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
  2. 2Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York City, New York, USA
  3. 3Transplantation-Oncology Infectious Diseases Program, Division of Infectious Diseases, WeillCornell Medical Center, New York-Presbyterian Hospital, New York City, New York, USA
  1. Correspondence to Dr Rocco J Richards, roc.richards{at}gmail.com

Summary

A 46-year-old previously healthy man presented with 1 week of headache, nausea, vomiting and dizziness. He was found to have cranial nerve deficits, his cerebrospinal fluid (CSF) demonstrated a lymphocytic pleocytosis and brain MRI suggested rhombencephalitis. Although Gram stains and cultures of his CSF did not identify a pathogen, Listeria monocytogenes DNA was detected by the FilmArray Meningitis/Encephalitis panel within 2 hours of performing a lumbar puncture. He was treated with ampicillin and gentamicin and had a near-complete recovery. This case highlights the importance of recognising L. monocytogenes infection as a cause of acute cranial nerve impairment with MRI findings suggestive of brainstem encephalitis. It also highlights the frequently atypical CSF profile and low yield of culture in L. monocytogenes rhombencephalitis and the value of multiplex PCR testing of CSF to rapidly identify this pathogen and permit targeted therapy.

  • foodborne infections
  • meningitis

https://doi.org/10.1136/bcr-2018-225575

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    Footnotes

    • Contributors All authors served important roles in the drafting and editing of the manuscript. RJR, MSS, LL and MS contributed to direct patient care. SGJ established the microbiological diagnosis and CDP provided the radiographic diagnosis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.