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Updated: Dec 28, 2025
Listeria monocytogenes Infection of the Brain
Published on: October 2, 2018
Supratentorial Listeria monocytogenes Brain Abscess in a Patient with Liver Cirrhosis
Romulo Omar Flores-Perez1, Cesar Daniel Villarreal-Villarreal1, Jesus Alberto Cardenas-de La Garza1
1Department of Internal Medicine, Autonomous University, Faculty of Medicine and University Hospital Dr. José Eleuterio González, Monterrey, México.
Abstract:
Meningitis and meningoencephalitis account for the majority of central nervous system infections by Listeria monocytogenes (Lm). Macroscopic listerial brain abscess is a rare infection. Early recognition of Listeria brain abscesses represents a major diagnostic challenge. Mortality from Listeria brain abscesses is high but can be reduced when appropriate treatment is timely started. Immunosuppressed patients are more often affected, and a high suspicion is needed for prompt identification. Treatment should be individualized taking into account the comorbidities, lesion size and location, bacterial resistance, and clinical and radiological response. We present a case of a supratentorial Lm brain abscess in a patient with liver cirrhosis whose family denied surgical management, and despite the large size, clinical and radiological success was achieved with 4 weeks of ampicillin.
Insights
Listeria monocytogenes brain abscesses are rare but dangerous central nervous system infections. This case highlights successful ampicillin treatment in a patient with liver cirrhosis, even without surgery.
Area of Science:
- Neuroscience
- Infectious Diseases
- Microbiology
Background:
- Central nervous system infections caused by Listeria monocytogenes (Lm) primarily manifest as meningitis or meningoencephalitis.
- Macroscopic brain abscesses due to Lm are uncommon and pose significant diagnostic challenges.
- Prompt identification and treatment are crucial for reducing high mortality rates associated with Listeria brain abscesses.
Observation:
- The case involved a supratentorial Lm brain abscess in a patient with liver cirrhosis.
- The patient's family opted against surgical intervention for the large abscess.
- Treatment consisted of 4 weeks of ampicillin, with no surgical management.
Findings:
- Despite the large size of the abscess and denial of surgery, clinical and radiological success was achieved.
- Ampicillin monotherapy proved effective in treating the Lm brain abscess in this specific case.
- Individualized treatment considering comorbidities, lesion characteristics, and bacterial susceptibility is essential.
Implications:
- This case suggests that conservative management with antibiotics like ampicillin can be successful for Lm brain abscesses, even in large cases.
- Highlights the importance of high clinical suspicion for Listeria in immunosuppressed patients, particularly those with underlying conditions like liver cirrhosis.
- Emphasizes the need for tailored treatment strategies in managing rare but severe central nervous system infections.
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