Listeria rhombencephalitis in the postpartum period

We present a case of Listeria rhombencephalitis (brainstem encephalitis) with abscess formation in a healthy woman in her late 30s at 6 weeks postpartum, presenting with acute onset of fever, headache and neurologic deficits. The diagnosis was confirmed with a positive Listeria monocytogenes cerebral spinal fluid (CSF) PCR assay and contrast-enhanced brain MRI revealing multiple brainstem abscesses. The patient's course was complicated by aspiration pneumonia due to bulbar dysfunction and neuromuscular respiratory failure, requiring prolonged intubation. The patient was treated with an 8 week course of ampicillin and gentamicin and was discharged home with residual, though improving, hemiparesis and cranial neuropathy. This case highlights the importance of considering Listeria rhombencephalitis in postpartum women with neurologic deficits and fever, even in the absence of meningeal signs. It also emphasises the crucial role of early diagnosis and treatment in reducing mortality and the severity of neurologic sequelae.