[A case of community-acquired Listeria monocytogenes meningitis]

Meningitis caused by Listeria monocytogenes is a rare disease in immunocompetent individuals, however, in the presence of certain risk factors with clinical signs indicating infection of the central nervous system it should not be ignored. In this case report, we present the medical history of a 72-year-old man, suffering from hypertension and liver cirrhosis, who was diagnosed with meningitis caused by L. monocytogenes. The patient was admitted to our Department with the symptoms of weakness, dizziness, high fever and urinary incontinence. Laboratory tests showed elevated inflammatory and liver enzyme values as well as low white blood cell and platelet counts were confirmed. Imaging tests did not prove any abnormalities. Due to septic parameters, after microbiological samples were collected, empiric ceftriaxon and metronidazol treatment was started. Despite our therapeutic efforts, the condition of the patient had not improved significantly. The patient still suffered from high fever; increasing agitation and tremor, coordination disorder appeared, raising the possibility of a bacterial infection of the central nervous system. Examination of the cerebrospinal fluid confirmed the diagnosis of bacterial meningitis. In the meantime, findings of microbiological cultures verified the infection of L. monocytogenes, however, cerebrospinal fluid culture did not detect any pathogen. Following that, the therapy continued with targeted ampicillin which resulted in rapid improvement of the patient's condition; fevers and neurological symptoms have ceased to exist. We considered the case worthy of presentation because of the pitfalls of the diagnosis, the emerging differential diagnostic difficulties and the favorable outcome due to the effectiveness of targeted antibiotic treatment. Orv Hetil. 2023; 164(36): 1437-1441.