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Abstract Details

Listeria Rhombencephalitis Mimicking a Focal Demyelinating Lesion
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
084
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Listeria monocytogenes (LM) is a gram-positive bacterium, which cause central nervous system infection in immunocompromised patients. Herein we report an immunocompetent woman developing a severe LM rhombencephalitis, which was initially assessed as a focal demyelinating lesion in the medulla. 
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A 58-year-old woman was hospitalized with mild headache and right facial sensory change. Her neurological examination revealed signs of mild pinprick and temperature sensory loss of right V1-V3 area, 50%. Magnetic resonance imaging (MRI) of the brain revealed non enhancing lesions with mild edema in right medulla. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis and mild hypoglycorrhachia. With assessment of a demyelinating lesion, methylprednisolone 250 mg was initiated. Initially, her facial numbness improved a bit, however at the fifth day of methylprednisolone, fever was documented and her neurologic symptoms got aggravated.  Checking of right side, motor grade was 4 and pinprck sensory was 60%. Follow-up MRI revealed rim-enhancing lesions with swelling in upper cervical spinal cord and diffuse leptomeningeal enhancement of  brain stem and cisternal space. Follow-up CSF analysis was also aggravated. Blood culture revealed LM after 48 hour incubation. Ampicillin and gentamicin were initiated. After 7 days of antibiotics administration, symptoms started to improve and after 1-month, she almost recovered only with mild neurologic sequelae.  
The listeria rhombencephalitis is an uncommon but severe infection of the brainstem that typically has a biphasic course with prodromal symptoms followed by brainstem deficits. There are several differential points with demyelinating disease and infectious disease of CNS: 1) the absence of oligoclonal bands in the CSF with normal IgG index, 2) CSF pleocytosis (>50 cells/uL and hypoglycorrhachia, 3) development of fever, and 4) lesion progression in MRI after therapy with corticosteroids. Patients with a focal brainstem lesion, along with above-mentioned conditions, should be evaluated carefully for the possibility of LM. 
Authors/Disclosures
Hee Jae Jung, MD (Asan Medical Center)
PRESENTER 		Dr. Jung has nothing to disclose.
Eun-Jae Lee, MD, PhD (Asan Medical Center) The institution of Prof. Lee has received research support from Republic of Korea .