A 49‐year‐old man presents with acute‐onset fever and confusion for one day. He has a history of type 2 diabetes mellitus and polycythemia vera complicated by myelofibrosis, and he underwent bone marrow transplant 3 months prior to admission. He is maintained on weekly chemotherapy via a mediport. His medications included cyclosporine, prednisone, voriconazole, atovaquone, and valganciclovir. On initial exam, he was febrile to 103°F and oriented only to person and time. He had no focal neurological findings. Laboratory studies were significant for pancytopenia(white blood cell count 3.9 × 10 9/L, hemoglobin 10.7 g/dL, platelet count 37 × 109/L) and a coagulopathy (PT of 19.3 seconds, INR of 1.6). CT head showed a large hypodense lesion, and contrast brain MRI revealed a 1.6‐cm multilobulated hypodensity in the right frontal lobe with central ring‐enhancement and associated reactive edema and mass effect. His cerebrospinal fluid(CSF) was hazy and analysis revealed a neutrophilic leukocytosis as well as abnormal chemistries (WBC 88 cells/μL with neutrophils of 56%, protein 162 mg/dL and glucose level 29 mg/dL). CSF gram stain and culture were negative. Infectious diseases was consulted for the management of brain abscess and empiric treatment with Vancomycin, Cefepime, Acyclovir, and fluconazole was recommended. Within 24 hours the peripheral blood cultures grew Listeria monocytogenes in 4 of 4 bottles, and ampicillin was added. Given the patient's rapid improvement with medical therapy, no neurosurgical intervention was performed. The patient was subsequently transferred to an outside hospital to the care of his primary oncologist. In follow‐up, the patient reportedly continued to improve radiologically and has been discharged home on oral antibiotics with no report of any residual neurological deficits.
Common central nervous system (CNS) manifestations of listeriosis include meningitis and rhomboencephalitis. Although the occurrence of brain abscess is rare, it represents up to1 0% of CNS listeriosis. Its mortality approximates 40% — nearly 3 times higher than nonlisterial brain abscesses. Unlike with other pathogens associated with brain abscess, it is not uncommon that the peripheral cultures are positive while the CSF cultures are negative. The potentially fulminant and fatal course of this disease emphasizes the significance of early diagnosis and appropriate treatment. Most patients with listerial brain abscess have medical comorbidities and are immunosuppressed. Indeed, our patients' use of immunosuppressive agents and corticosteroids in particular, is a common risk factor. Associated underlying diseases frequently include cancers such as lymphoma and leukemia, as well as HIV and AIDS. To our knowledge, our report is the first to describe listerial brain abscess in a patient with polycythemia vera and myelofibrosis.
This case illustrates the importance of clinical suspicion and early initiation of treatment for listerial brain abscess in patients with impaired immunity.
To cite this abstract:Noshiro K, Dharapak P. Brain Abscess Caused by Listeria Monocytogenes. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 403. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/brain-abscess-caused-by-listeria-monocytogenes/. Accessed April 4, 2020.