Open AccessRapid detection of Listeria monocytogenes rhombencephalitis in an immunocompetent patient by multiplexed PCR
Author(s) -
Rocco J. Richards,
Matthew S. Simon,
C. Douglas Phillips,
Lindsay Lief,
Stephen G. Jenkins,
Michael S Satlin
Publication year - 2018
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-225575
Subject(s) - medicine , pleocytosis , listeria monocytogenes , lymphocytic pleocytosis , lumbar puncture , cerebrospinal fluid , csf pleocytosis , meningitis , encephalitis , vomiting , pathology , immunology , surgery , bacteria , biology , virus , genetics
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.