Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis
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Updated: Dec 14, 2025
An Immunohistopathologic Study to Profile the Folate Receptor Beta Macrophage and Vascular Immune Microenvironment in Giant Cell Arteritis
Published on: February 8, 2019
Christos Vettas1, Athina Dimosiari1, Christina Kydona1
1Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Background:
Listeria monocytogenes is an opportunistic pathogen that causes severe infections of the Central Nervous System, such as meningitis or meningoencephalitis, and brain abscesses. Abscesses account for approximately 1-10% of CNS listerial infections and are observed in 1% of all listerial infections.
Methods:
We describe a case of 70-year-old male patient who had several admissions in different hospitals over the last 8 weeks.
Results:
He suffered from intermittent fever for over a month, recurrent episodes of headaches, disorientation and other neurological symptoms. His condition was misdiagnosed as giant cell arteritis and initially the patient was started on corticosteroids. MRI of the brain revealed the presence of multiple brain abscesses and the cerebrospinal fluid study confirmed the presence of Listeria Monocytogenes. The patient was started on ampicillin and he completed a 6 weeks' course of treatment.
Conclusions:
This case emphasizes the need to include rare pathogens in the differential diagnosis when possible CNS infections are involved, as well as to show that in many cases some auto-immune diseases are overdiagnosed.
Insights
This case highlights Listeria monocytogenes brain abscesses, a rare central nervous system infection. Early diagnosis and treatment are crucial for managing these severe neurological conditions.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Listeria monocytogenes is a significant cause of central nervous system (CNS) infections, including meningitis, meningoencephalitis, and brain abscesses.
- Brain abscesses represent a less common but severe manifestation of CNS listerial infections, occurring in 1-10% of such cases.
Observation:
- A 70-year-old male presented with prolonged intermittent fever, recurrent headaches, disorientation, and neurological deficits over eight weeks.
- Initial misdiagnosis as giant cell arteritis led to corticosteroid treatment.
- Brain MRI revealed multiple abscesses, and cerebrospinal fluid analysis confirmed Listeria Monocytogenes.
Findings:
- The patient received a 6-week course of ampicillin for Listeria Monocytogenes brain abscesses.
- Successful treatment of CNS listeriosis was achieved with appropriate antibiotic therapy.
Implications:
- This case underscores the importance of considering rare pathogens in the differential diagnosis of CNS infections.
- Highlights the potential for overdiagnosis of autoimmune diseases when infectious etiologies are present.
- Emphasizes the need for timely and accurate diagnosis to guide appropriate treatment for severe neurological infections.
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