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Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia

INTRODUCTION: Listeria monocytogenes is an important opportunistic pathogen affecting patients with immunosuppression and shows a high tropism for the central nervous system. The clinical manifestations of central nervous system listerial infections are variable and represent a diagnostic challenge....

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Autores principales: Bajkó, Zoltán, Bălaşa, Rodica, Maier, Smaranda, Moţăţăianu, Anca, Treabă, Andrada, Macarie, Ioan, Gârbovan, Cristina, Chiriac, Carmen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Healthcare 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389028/
https://www.ncbi.nlm.nih.gov/pubmed/26000217
http://dx.doi.org/10.1007/s40120-013-0009-y
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author Bajkó, Zoltán
Bălaşa, Rodica
Maier, Smaranda
Moţăţăianu, Anca
Treabă, Andrada
Macarie, Ioan
Gârbovan, Cristina
Chiriac, Carmen
author_facet Bajkó, Zoltán
Bălaşa, Rodica
Maier, Smaranda
Moţăţăianu, Anca
Treabă, Andrada
Macarie, Ioan
Gârbovan, Cristina
Chiriac, Carmen
author_sort Bajkó, Zoltán
collection PubMed
description INTRODUCTION: Listeria monocytogenes is an important opportunistic pathogen affecting patients with immunosuppression and shows a high tropism for the central nervous system. The clinical manifestations of central nervous system listerial infections are variable and represent a diagnostic challenge. CASE REPORT: The authors report the case of a 59-year-old woman who was admitted for confusion, agitation, and right-lower extremity weakness. The patient was treated for 3 months with fludarabine and 2 months with corticosteroids for chronic lymphocytic leukemia and hemolytic anemia, respectively. At the time of admission, the neurological examination revealed grade 4 right-lower extremity weakness with reflex asymmetry and right-sided Babinski sign; no signs of meningeal irritation were detectable. Physical examination was notable for grade 1 obesity and subfebrility. The cerebral computed tomography scan demonstrated a hypodense lesion in the left frontal lobe. Cerebral magnetic resonance imaging revealed a hyperintense lesion in the left frontal lobe with extension toward the basal ganglia (T2 and Fluid-Attenuated Inversion Recovery [FLAIR] sequences), and small nodular enhancing lesions after gadolinium infusion in the affected territory. Blood analyses revealed pancytopenia and elevated liver enzymes. During the second day after admission, the patient developed fever and neurological examination revealed signs of meningeal irritation. The cerebrospinal fluid (CSF) analyses revealed: red blood cells 24 cells/mm(3); white blood cells 829 cells/mm(3) (76% lymphocytes, 22% neutrophils, 2% monocytes); protein level 111.2 mg/dL; glucose level 10.2 mg/dL. Empiric anti-infection treatment was started with intravenous ceftriaxone, ciprofloxacine, aciclovir, and fluconasole. Both blood cultures and CSF cultures were positive for L. monocytogenes. The antimicrobial regimen was changed to ampicillin. The clinical and imaging outcome was excellent. CONCLUSION: The supratentorial focal lesions secondary to Listeria meningoencephalitis are rare. The cases with focal neurological signs without fever at onset can resemble stroke.
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spelling pubmed-43890282015-05-21 Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia Bajkó, Zoltán Bălaşa, Rodica Maier, Smaranda Moţăţăianu, Anca Treabă, Andrada Macarie, Ioan Gârbovan, Cristina Chiriac, Carmen Neurol Ther Case Report INTRODUCTION: Listeria monocytogenes is an important opportunistic pathogen affecting patients with immunosuppression and shows a high tropism for the central nervous system. The clinical manifestations of central nervous system listerial infections are variable and represent a diagnostic challenge. CASE REPORT: The authors report the case of a 59-year-old woman who was admitted for confusion, agitation, and right-lower extremity weakness. The patient was treated for 3 months with fludarabine and 2 months with corticosteroids for chronic lymphocytic leukemia and hemolytic anemia, respectively. At the time of admission, the neurological examination revealed grade 4 right-lower extremity weakness with reflex asymmetry and right-sided Babinski sign; no signs of meningeal irritation were detectable. Physical examination was notable for grade 1 obesity and subfebrility. The cerebral computed tomography scan demonstrated a hypodense lesion in the left frontal lobe. Cerebral magnetic resonance imaging revealed a hyperintense lesion in the left frontal lobe with extension toward the basal ganglia (T2 and Fluid-Attenuated Inversion Recovery [FLAIR] sequences), and small nodular enhancing lesions after gadolinium infusion in the affected territory. Blood analyses revealed pancytopenia and elevated liver enzymes. During the second day after admission, the patient developed fever and neurological examination revealed signs of meningeal irritation. The cerebrospinal fluid (CSF) analyses revealed: red blood cells 24 cells/mm(3); white blood cells 829 cells/mm(3) (76% lymphocytes, 22% neutrophils, 2% monocytes); protein level 111.2 mg/dL; glucose level 10.2 mg/dL. Empiric anti-infection treatment was started with intravenous ceftriaxone, ciprofloxacine, aciclovir, and fluconasole. Both blood cultures and CSF cultures were positive for L. monocytogenes. The antimicrobial regimen was changed to ampicillin. The clinical and imaging outcome was excellent. CONCLUSION: The supratentorial focal lesions secondary to Listeria meningoencephalitis are rare. The cases with focal neurological signs without fever at onset can resemble stroke. Springer Healthcare 2013-07-02 /pmc/articles/PMC4389028/ /pubmed/26000217 http://dx.doi.org/10.1007/s40120-013-0009-y Text en © The Author(s) 2013 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Case Report
Bajkó, Zoltán
Bălaşa, Rodica
Maier, Smaranda
Moţăţăianu, Anca
Treabă, Andrada
Macarie, Ioan
Gârbovan, Cristina
Chiriac, Carmen
Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
title Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
title_full Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
title_fullStr Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
title_full_unstemmed Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
title_short Listeria monocytogenes Meningoencephalitis Mimicking Stroke in a Patient with Chronic Lymphocytic Leukemia
title_sort listeria monocytogenes meningoencephalitis mimicking stroke in a patient with chronic lymphocytic leukemia
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389028/
https://www.ncbi.nlm.nih.gov/pubmed/26000217
http://dx.doi.org/10.1007/s40120-013-0009-y
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