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[Fulminant meningoencephalitis due to Listeria monocytogenes]
R Manzanares1, E Aguilar, E Rodríguez del Alba
1Servicio de Hematología, Hospital S.V.S. Virgen de los Lirios, Alcoy, Alicante.
Abstract:
We present a case of meningoencephalitis due to Listeria monocytogenes type IV in a patient in which the diagnosis of small-cells malignant diffuse non-Hodgkin's lymphoma had been established. He was hospitalized with vague clinical manifestations and without showing any neurological focus. Hours later, he presented clinical brain stem semiology. Within a 24-hour period, Listeria monocytogenes was isolated from blood and cephalorhachidian fluid (being the first time that this microorganism had been isolated for the past 20 years in our laboratory). The patient evolved to a state of coma, with Cheyne-Stokes's respiration, abolition of pupillary reflexes, decerebration position and exitus laetalis. The affection of the central nervous system has been fully documented. However, its fulminant presentation, as in the case that we present here, is less frequent, although it has been described in the literature by other authors, like Finegold et al., with cases in which the interval between the onset of the neurological focality and death ranged from 8 to 16 hours. The antibiogram showed a wide sensibility to several groups of drugs, despite the fast evolution of the disease that prevented the modification of the initial antibiotherapy (Vancomicine and imipenem).
Insights
This case study highlights a rare, rapid meningoencephalitis caused by Listeria monocytogenes in a lymphoma patient. Despite broad antibiotic sensitivity, the infection progressed fatally within 24 hours.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- This report details a rare case of meningoencephalitis in a patient diagnosed with small-cell malignant diffuse non-Hodgkin's lymphoma.
- The patient presented with non-specific symptoms, rapidly progressing to severe neurological deficits.
Observation:
- Listeria monocytogenes, type IV, was identified in blood and cerebrospinal fluid within 24 hours of hospitalization.
- The patient exhibited rapid deterioration, including coma, Cheyne-Stokes respiration, and decerebration, leading to death.
Findings:
- The central nervous system involvement was confirmed, characterized by a fulminant clinical course.
- This rapid progression, from initial neurological signs to death within 8-16 hours, is infrequently documented.
Implications:
- This case underscores the potential for severe, rapidly progressing Listeria monocytogenes infections in immunocompromised individuals, such as lymphoma patients.
- Despite broad antibiotic susceptibility, the swiftness of the disease highlights challenges in timely therapeutic intervention.
- Early recognition and aggressive management are crucial for improving outcomes in such critical cases.