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[Headaches and aphasia in an immunocompromised patient]

S Tschudin1, G Laifer, C Orasch

  • 1Klinik für Infektiologie und Spitalhygiene, Universitätsspital Basel.

Praxis
|July 9, 2009
PubMed

Insights

A brain abscess caused by Listeria monocytogenes in an immunocompromised patient was successfully treated with prolonged antibiotics. This case highlights Listeria CNS invasion as a rare but serious manifestation, emphasizing the need for timely diagnosis and treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Listeria monocytogenes is a pathogen that primarily affects immunocompromised individuals, the elderly, newborns, and pregnant women.
  • Central nervous system (CNS) invasion by Listeria can manifest as meningitis, meningoencephalitis, or less commonly, brain abscesses (5-10% of cases).

Observation:

  • An 81-year-old immunocompromised patient presented with new-onset headaches and word-finding difficulties.
  • Brain MRI revealed a left temporal mass with marginal contrast enhancement.
  • Blood cultures subsequently grew Listeria monocytogenes, confirming a brain abscess.

Findings:

  • Surgical drainage was not feasible due to abscess location.
  • A prolonged antibiotic therapy course of over 4.5 months was administered.
  • Post-treatment MRI showed complete resolution of the brain abscess.

Implications:

  • This case underscores the importance of considering Listeria monocytogenes in the differential diagnosis of brain abscesses, particularly in at-risk populations.
  • Prolonged antibiotic therapy can be an effective treatment strategy for non-surgically managed Listeria brain abscesses.
  • Early diagnosis and appropriate management are crucial for favorable outcomes in CNS Listeria infections.

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