Rhombencephalitis by Listeria Monocytogens in Two Diabetic Patients

Brainstem involvement is a characteristic feature and accounts for the high mortality associated with listeriosis especially in immunosuppressed patients. We report two cases of rhombencephalitis infection by Listeria monocytogenes in a 65 and 63-year-old men with diabetes. They were referred to a neurologist due to fever and drowsiness after 3 weeks. The 65-year-old man had vertigo, diplopia, ataxia, bidirectional nystagmus and the 63-year-old man complained of perioral numbness, dysphagia and dysartheria. Treatment with ampicillin (12 g/day) was started empirically and modified when the culture results were available. The CSF cultures were positive to Listeria monocytogenes and brain MRI findings were suggestive of rhomboencephalitis. Despite delays in treatment, they had a complete clinical recovery with resolution of MRI abnormalities. In contrast to our results, in most reports, a bi-phasic illness has 
been described and late treatment was associated with unfavorable courses or long lasting sequelae.