Rhombencephalitis due to Listeria monocytogenes infection with GQ1b antibody positivity and multiple intracranial hemorrhage: a case report and literature review

Abstract

Listeria monocytogenes is a Gram-positive facultative intracellular bacterium that causes central nervous system infection. We report a case of rhombencephalitis caused by L. monocytogenes infection, which mimicked Bickerstaff’s brainstem encephalitis, and GQ1b antibody positivity and multiple intracranial foci were observed. A 68-year-old male patient presented with a nonspecific prodrome of faintness, forehead tightness, and walking instability. This was followed by progressive cranial nerve palsies, limb weakness, cerebellar signs, hyperpyrexia, and impaired consciousness. Brain imaging showed multiple abnormal brainstem and cerebellar signals that were accompanied by blood infiltration without any lesion enhancement. Serum GQ1b antibody positivity led to an initial diagnosis of Bickerstaff’s brainstem encephalitis, which was treated with immunosuppressive therapy with limited efficacy. A pathogen examination helped confirm L. monocytogenes infection. A combination of meropenem and trimethoprim-sulfamethoxazole therapy was applied and the patient recovered without sequelae. The symptoms and imaging of Listeria rhombencephalitis are nonspecific. Accurate diagnosis and prompt treatment of this condition are essential. Whether Listeria infection triggers an autoimmune response remains unclear.

Epidemiología, clínica y resultados de imagen de rombencefalitis causada por L. monocytogenes. Un estudio observacional

“…La resonancia magnética (RM) ofrece una alta resolución espacial y tisular, y es muy útil para sugerir el diagnóstico de rombencefalitis. Sin embargo, no se dispone de protocolos específicos de RM para la sospecha de neurolisteriosis del sistema nervioso central, lo que puede retrasar el diagnóstico definitivo [ 2 ]. Los signos de rombencefalitis en la RM incluyen una intensidad de señal anormalmente alta en imágenes ponderadas en T 2 y realce patológico del parénquima cerebral o de los espacios de líquido cefalorraquídeo [ 3 ].…”

“…Magnetic resonance imaging (MRI) offers high spatial and tissue resolution and is very useful to suggest the diagnosis of rhombencephalitis. However, no specific MRI protocols are available for suspected central nervous system neurolisteriosis, which may delay the definite diagnosis [ 2 ]. MRI signs of rhombencephalitis include as abnormally high signal intensity on T 2 -weighted images, pathologic enhancement of the brain parenchyma or cerebrospinal fluid (CSF) spaces [ 3 ].…”

Atypical Imaging Findings in Anti-GQ1b Brainstem Encephalitis

“…This is also not common in GQ1b brainstem encephalitis, being reported previously in only two patients with Listeria rhombencephalitis with additional GQ1b antibody positivity. 10,11 The underlying mechanism of intracerebral microhemorrhages remains unknown but some have argued that it can be related to an autoimmune response associated, with vascular and endothelial cell activation, triggering the release of procoagulant factors and proinflammatory cytokines. 11 Although in our case report CSF investigations for Listeria were negative, we hypothesized that probably another nondetected infectious triggered an anti-GQ1b autoimmune response.…”