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Updated: Mar 28, 2026
Listeria monocytogenes Infection of the Brain
Published on: October 2, 2018
Rhombencephalitis due to Listeria monocytogenes: A Clinicopathologic Study of a Case
Álvaro Giménez-Muñoz1, Isabel Campello, José M Pérez Trullén
1Departments of *Neurology ‡Pathology, Royo Villanova Hospital †Department of Pathology, Miguel Servet University Hospital, Zaragoza, Spain.
Introduction:
Central nervous system infections caused by Listeria monocytogenes usually manifest in the form of meningitis or meningoencephalitis, and are more common among immunosuppressed patients. Brainstem encephalitis (rhombencephalitis) is less common and fatal if not recognized and treated early.
Case Report:
We describe the case of a 40-year-old, immunocompetent male patient, who presented with initial symptoms of high fever and productive cough. Signs of brainstem involvement appeared later. A magnetic resonance imaging of the brain revealed a lesion of inflammatory appearance in the right medulla oblongata, and the cerebrospinal fluid test showed mononuclear pleocytosis. Blood and cerebrospinal fluid cultures were negative. He presented with a significant improvement with the start of ceftriaxone and subsequent association of corticosteroids, until he developed respiratory failure and died. The third blood cultures grew after his death and they were positive for L. monocytogenes. An autopsy was carried out, which showed necrotizing inflammation, with gram-positive bacilli in the brainstem and the cerebellum.
Conclusions:
A fatal delay in the diagnosis occurred, mainly because of the favorable clinical response to ceftriaxone and corticosteroids. This case reminds us that a febrile clinical presentation with brainstem involvement must generate the suspicion of a Listeria infection, and therefore ampicillin must be a part of the empirical treatment.
Insights
Listeria monocytogenes rhombencephalitis is a rare but fatal infection. Early suspicion and ampicillin treatment are crucial for immunocompetent patients presenting with fever and brainstem signs.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Listeria monocytogenes (L. monocytogenes) typically causes meningitis or meningoencephalitis, primarily in immunosuppressed individuals.
- Rhombencephalitis, a less common form of central nervous system infection by L. monocytogenes, presents a high fatality rate if not promptly diagnosed and treated.
Observation:
- A case of a 40-year-old immunocompetent male with initial respiratory symptoms followed by brainstem involvement is presented.
- Magnetic resonance imaging revealed a brainstem lesion, and cerebrospinal fluid analysis showed mononuclear pleocytosis.
- Despite initial improvement with ceftriaxone and corticosteroids, the patient developed respiratory failure and died; post-mortem blood cultures confirmed L. monocytogenes.
Findings:
- The autopsy revealed necrotizing inflammation with gram-positive bacilli in the brainstem and cerebellum.
- A delay in diagnosis occurred due to a misleading initial response to ceftriaxone and corticosteroids.
- L. monocytogenes was confirmed posthumously via blood cultures.
Implications:
- Febrile presentations with brainstem involvement should raise suspicion for Listeria infection, even in immunocompetent individuals.
- Ampicillin should be considered in empirical treatment regimens for suspected Listeria rhombencephalitis.
- This case underscores the importance of early and accurate diagnosis for improving outcomes in CNS Listeria infections.
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