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Updated: Aug 29, 2025
Listeria monocytogenes Infection of the Brain
Published on: October 2, 2018
One-year-old boy with refractory Listeria monocytogenes meningitis due to persistent hypercytokinemia
Shuya Kaneko1, Kiyoshi Hatasaki1, Kazuyuki Ueno1
1Department of Pediatrics, Toyama Prefectural Central Hospital, Toyama, Japan.
Abstract:
We had a case of Listeria monocytogenes (LM) meningitis complicated with hypercytokinemia and hemophagocytic lymphohistiocytosis in a healthy 22-month-old boy. He was admitted to our hospital with a fever, vomiting, mild consciousness disturbances, and extraocular muscle paralysis. Magnetic resonance imaging (MRI) revealed bilateral deep white matter lesions. After receiving ampicillin, meropenem, and gentamicin, his cerebrospinal fluid (CSF) culture results turned negative on the third day of hospitalization. However, the fever intermittently persisted, and it took approximately 40 days to completely resolve. During this period, various inflammatory cytokine levels, particularly neopterin, in the blood and CSF remained elevated. Therefore, long-term administration of corticosteroids in addition to antibiotics was required. The use of dexamethasone appeared to be effective for neurological disorders such as consciousness disturbance and extraocular muscle paralysis associated with abnormal brain MRI findings. LM meningitis may present with encephalopathy and persistent fever due to hypercytokinemia. In such cases, corticosteroid therapy should be considered.
Insights
Listeria monocytogenes meningitis can cause severe hypercytokinemia and hemophagocytic lymphohistiocytosis in children. Corticosteroid therapy, alongside antibiotics, may be crucial for resolving neurological symptoms and persistent fever.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Immunology
Background:
- Listeria monocytogenes (LM) meningitis is a serious infection, particularly in infants.
- Hypercytokinemia and hemophagocytic lymphohistiocytosis (HLH) are potential complications.
- Neurological sequelae can arise from severe LM meningitis.
Observation:
- A healthy 22-month-old boy developed LM meningitis with fever, vomiting, altered consciousness, and extraocular muscle paralysis.
- Brain MRI showed bilateral deep white matter lesions.
- Despite initial antibiotic treatment, persistent fever and elevated inflammatory cytokines (neopterin) were observed for 40 days.
Findings:
- Antibiotic therapy alone was insufficient to resolve persistent hypercytokinemia and neurological symptoms.
- Long-term corticosteroid administration, specifically dexamethasone, was required.
- Dexamethasone effectively treated neurological deficits including consciousness disturbance and extraocular muscle paralysis.
Implications:
- Listeria monocytogenes meningitis can manifest with encephalopathy and prolonged fever due to hypercytokinemia.
- Corticosteroid therapy should be strongly considered in managing complex LM meningitis cases with hypercytokinemia and neurological involvement.
- This case highlights the importance of a multimodal treatment approach for severe LM meningitis.
