A 60-year-old female was admitted to our clinic with fever, headache, weakness, and confusion. Her past medical history was unremarkable other than ulcerative colitis (UC), and she received 4 g/day mesalamine, 100 mg/day azathioprine, and 25 mg/day prednisolone on admission. Because of UC activation 1 month previously, azathioprine and prednisolone were initiated at initial doses of 50 and 40 mg/day, respectively. The prednisolone dose was decreased by 5 mg weekly, whereas the azathioprine dose was increased to 100 mg in the second week. Physical examination revealed that her body temperature was 38.4°C. She had right hemiparesis, neck stiffness, and confusion. Laboratory test results were as follows: hemoglobin level, 10.9 g/ dL (11.7-15.5 g/dL); white blood cell (WBC) count, /μL), and C-reactive protein level, 15.8 mg/ dL (0-0.3 mg/dL). Liver enzyme and creatinine levels were normal. Magnetic resonance imaging (MRI) findings of the patient were consistent with meningitis. Lumbar puncture was performed, and cell count of the cerebrospinal fluid (CSF) was 600/mm 3 WBCs, with 40% neutrophil and abundant erythrocytes. Gram-positive rods were detected in the Gram stain of CSF. Meropenem plus ampicillin was administered to the patient for a central nervous system (CNS) infection. Azathioprine was discontinued, and the prednisolone dose was gradually reduced (5 mg/1-4 day) because of the infection. The control cranial MRI in the second week revealed a left thalamo-mesencephalic abscess (Figure 1).Listeria monocytogenes (LM) was identified in the CSF culture. Meropenem was switched to gentamicin, and gentamicin plus ampicillin was continued for 1 month. The patient clinically improved, and the control cranial MRI in the sixth week showed a marked improvement of the abscess (Figure 2). She was discharged from the hospital with continuing treatment of 4 g/day mesalamine for UC. 2017; 28: 137-9 An unusual neurological complication in a patient with ulcerative colitis 137 Figure 1. Cranial magnetic resonance image revealing left thalamo-mesencephalic abscess. The lesion is T2 hypointense and T1 hyperintense and has an irregularly contrast-enhanced rim. Diffusion-weighted imaging shows restricted diffusion in the central region of the lesion
Turk J Gastroenterol