Simultaneous supratentorial and brainstem abscesses due to Listeria monocytogenes

Soares-Fernandes, João; Beleza, Pedro; Cerqueira, João José; Ribeiro, Manuel; Maré, Ricardo; Lourenço, Esmeralda; Rocha, Jaime

doi:10.1016/j.neurad.2007.07.009

Cited by 15 publications

(9 citation statements)

References 14 publications

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“…There were no fever, nausea, vomiting, or diarrhea reported before or after admission to our hospital. Blood tests revealed mild leukocytosis, which was aligned with the previous reports [9,10]. CSF analysis showed elevated levels of lactate, which has been reported as a useful diagnostic marker to differentiate between viral CNS infections and Listeria or other bacterial infections [11].…”

Section: Discussionsupporting

confidence: 88%

Multiple Listeria Abscesses in an Immunocompetent Patient

Frade

Pingili

Nattanamai

2020

Cureus

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Section: Discussionsupporting

confidence: 88%

Multiple Listeria Abscesses in an Immunocompetent Patient

Frade

Pingili

Nattanamai

2020

Cureus

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“…4,10,20,21 Of the remaining 11, 3 involved the brainstem without involving the cerebral hemispheres and thus were excluded. 6,25,28 In the 8 final cases from the literature, 1 case was of bilateral abscesses that did not follow a fiber tract, 23 1 case was also bilateral but with abscesses (possibly) following the fiber tracts on 1 side, 38 while in the remaining 6, 1,16,26,29,37 to which we added our own case for a total of 7, all the abscesses were located exclusively in the same hemisphere and were distributed along white matter fiber tracts (Table 1). In the majority of cases, the distribution was along the projection fiber tracts toward the brainstem, but in some cases, as in ours, the short and long association fibers were also affected.…”

Section: Literature Reviewmentioning

confidence: 99%

Spreading of multiple Listeria monocytogenes abscesses via central nervous system fiber tracts: case report

Bojanowski¹,

Seizeur

Effendi³

et al. 2015

JNS

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Animal studies have shown that Listeria monocytogenes can probably access the brain through a peripheral intraneural route, and it has been suggested that a similar process may occur in humans. However, thus far, its spreading through the central nervous system (CNS) has not been completely elucidated. The authors present a case of multiple L. monocytogenes cerebral abscesses characterized by a pattern of distribution that suggested spread along white matter fiber tracts and reviewed the literature to identify other cases for analysis. They elected to include only those cases with 3 or more cerebral abscesses to make sure that the distribution was not random, but rather followed a pattern. In addition, they included those cases with abscesses in both the brainstem and the cerebral hemispheres, but excluded cases in which abscesses were located solely in the brainstem. Of 77 cases of L. monocytogenes CNS abscesses found in the literature, 17 involved multiple abscesses. Of those, 6 were excluded for lack of imaging and 3 because they involved only the brainstem. Of the 8 remaining cases from the literature, one was a case of bilateral abscesses that did not follow a fiber tract; another was also bilateral, but with lesions appearing to follow fiber tracts on one side; and in the remaining 6, to which the authors added their own case for a total of 7, all the abscesses were located exclusively in the same hemisphere and distributed along white matter fiber tracts. The findings suggest that after entering the CNS, L. monocytogenes travels within the axons, resulting in a characteristic pattern of distribution of multiple abscesses along the white matter fiber tracts in the brain. This report is the first description suggesting intraaxonal CNS spread of L. monocytogenes infection in humans following its entry into the brain. This distinct pattern is clearly seen on imaging and its recognition may be valuable in the diagnosis of listeriosis. This finding may allow for earlier diagnosis, which may improve outcome.

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“…CNS infections due to LM have been reported to be extremely rare in UC patients, and almost all cases are related to anti-TNF agents (3)(4)(5). Besides anti-TNF agent-related cases, one UC case complicated with LM has been reported in the literature; the case was related to azathioprine therapy (6). The current case is the second reported occurrence that is related to azathioprine therapy.…”

Section: -72) (1)mentioning

confidence: 70%

“…Patients generally present with fever, altered mental status, headache, and focal neurological findings (3)(4)(5)(6). Culture, Gram stain, cell count, and glucose/ protein measurement of CSF; blood cultures; and cranial MRI are used for a definitive diagnosis (2).…”

Section: -72) (1)mentioning

confidence: 99%

An unusual neurological complication in a patient with ulcerative colitis

Köklü

Aksoy²,

Öztürk³

et al. 2017

Turk J Gastroenterol

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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

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Simultaneous supratentorial and brainstem abscesses due to Listeria monocytogenes

Cited by 15 publications

References 14 publications

Multiple Listeria Abscesses in an Immunocompetent Patient

Multiple Listeria Abscesses in an Immunocompetent Patient

Spreading of multiple Listeria monocytogenes abscesses via central nervous system fiber tracts: case report

An unusual neurological complication in a patient with ulcerative colitis

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