Recurrent Listeria monocytogenes meningitis in a heart transplant recipient

Area of Science:

• Infectious Diseases
• Transplantation Immunology
• Neurology

Background:

• Heart transplantation is a complex procedure requiring immunosuppression.
• Allograft rejection episodes necessitate intensified immunosuppressive therapy, often with corticosteroids.
• Listeria monocytogenes is an opportunistic pathogen that can cause severe infections, particularly in immunocompromised individuals.

Observation:

• A patient experienced two distinct episodes of Listeria monocytogenes meningitis.
• These meningitis episodes occurred at 4 and 8 months post-heart transplantation.
• Both episodes were temporally associated with increased corticosteroid dosage for managing allograft rejection.

Findings:

• Recurrent Listeria monocytogenes meningitis following heart transplantation is a rare but serious complication.
• Corticosteroid therapy for allograft rejection may increase susceptibility to Listeria monocytogenes infection.
• The specific source of L. monocytogenes in this recurrent case was not identified.

Implications:

• This case underscores the importance of vigilance for opportunistic infections in heart transplant recipients, especially during periods of heightened immunosuppression.
• Clinicians should consider Listeria monocytogenes meningitis in immunocompromised patients presenting with neurological symptoms, particularly after transplantation and corticosteroid use.
• Further research into the mechanisms and prevention of recurrent Listeria infections in transplant patients is warranted.