Polyradiculitis, Perimyocarditis, and Nephrotic Syndrome: Unusual Manifestations of Infection Due to Listeria monocytogenes

Abstract

infectious polyradiculitis, which, to our knowledge, has not yet been While receiving intravenous antibiotic therapy (ampicillin, 2 g six reported in association with L. monocytogenes infection, best explains times daily, and gentamicin, 240 mg/day), the patient developed distal our findings. flaccid peripheral pareses within the first 4 days. Foot flexion andThe patient developed a nephrotic syndrome with hypoalbumiextension were not possible on the left and were impaired on the right. nemia, pleural effusions, and proteinuria, which resolved with Arm muscle weakness was moderate on the left and severe on the symptomatic treatment. Infection of the pleural cavity with L. moright. Deep tendon reflexes had diminished, and the ankle reflexes were nocytogenes [6,7] is unlikely because of regressive inflammatory absent. The patient complained of tingling in the hands and feet, and parameters at the time of onset. Therefore, parainfectious etiology vibratory sensation was diminished distally (3/8). Cranial and spinal of nephrotic syndrome was assumed, although, to our knowledge, MRIs were normal. Somatosensory evoked responses showed no pean association with L. monocytogenes infection has not yet been ripheral waves. Brainstem auditory evoked responses were normal.described. Infectious pericarditis and myocarditis due to L. monoNerve conduction studies revealed absent (left median, right ulnar, and cytogenes have been reported as serious complications [8, 9]. In right peroneal nerves) or delayed (left tibial nerve) F-wave responses the patient we described, perimyocarditis resolved rapidly. Thus, consistent with polyradiculitis. Motor nerve conduction velocities were a parainfectious etiology appears to be possible. No underlying normal or slightly reduced; distal motor latency was delayed in one autoimmune disease was found. Lymphoma or hypergammaglonerve. Compound muscle action potentials were slightly reduced in bulinemia due to myeloma or Waldenström's macroglobulinemia amplitude. Sensory nerve action potentials were diminished or missing.are unlikely causes, because organ complications remitted with Needle electromyography showed no denervation signs.antibiotic treatment. After 3 days, the patient developed respiratory impairment due toIn conclusion, in our immunocompetent patient with L. monocymuscle weakness (vital capacity, 1.4 L) and bilateral pleural effusions.togenes infection, the unusual manifestations of polyradiculitis, Blood tests revealed hypoalbuminemia (albumin level, 23 g/L) and nephrotic syndrome, and perimyocarditis took a benign course and nonselective proteinuria (protein excretion rate, 10 g/day), which sugshould be considered as possible complications in the management gested a nephrotic syndrome. The serum urea level was slightly eleof patients with L. monocytogenes infection. vated, whereas the creatinine level and creatinine clearance remained normal. Kidney biopsy showed mild focal and segmental glomerulo- 5. Bolton CF. Sepsis and the systemic inflammatory response syndrome: neu-

Prolonged dysphagia due to Listeria-rhombencephalitis with brainstem abscess and acute polyradiculoneuritis

“…There are only sporadic reports on acute polyradiculoneuritis resulting from Listeria so it should gain further interest. 11 We suggest that patients presenting with symptoms of unclear infection and clinical signs of brainstem involvement need to be evaluated for Listeria by repeated blood cultures, MRI and should receive empirical antibiotics covering this germ, until conclusive diagnosis.…”

Listerial meningitis in a patient with undiagnosed acquired immunodeficiency syndrome: ampicillin should be added to the empirical antibiotic coverage

“…Myocarditis caused by Listeria has been rarely reported. 3 Ampicillin plus gentamicin have generally been recommended as the treatment of choice. 4 Ampicillin combined with TMP-SMX has been reported to have a lower failure rate and few neurological sequelae than ampicillin combined with an aminoglycoside.…”

Acute meningitis

“…Mortality was 26% overall, and was higher among patients with seizures and those older than 65 years of age [7]. Acute polyradiculitis, as a very unusual manifestation of L. monocytogenes infection, was recently observed in a patient suffering from Listeria meningoencephalitis who developed flaccid peripheral paraparesis [8].…”