A Rare Case of Listeria Septicemia and Meningitis in Liver Cirrhosis

Patient: Male, 64-year-old Final Diagnosis: Listeria monocytogenes infection • Listeria septicemia • meningitis • shock Symptoms: Encephalopathy • sepsis • shock Medication:— Clinical Procedure: — Specialty: Critical Care Medicine OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Sepsis is a leading global cause of mortality, with the most common causative agents being Staphylococcus aureus, Streptococcus pneumoniae, andEscherichia coli. In septic patients with liver cirrhosis, the mortality rates are higher than in the general population due to altered liver function and an excessive innate immune response. In this demographic, sepsis is typically caused by spontaneous bacterial peritonitis or urinary tract infections and the causative agents are very predictable owing to known dysregulated immunological pathways studied in patients with cirrhosis. Listeria monocytogenes is not only a less common cause of sepsis, but also a rare cause in patients with cirrhosis. Moreover, concurrent meningitis and septicemia is even less common in this demographic. CASE REPORT: Herein we present a patient with known liver cirrhosis from chronic alcohol use who presented with generalized complaints and was admitted to the Intensive Care Unit with septic shock and concomitant liver failure. Although his changes in mentation were initially attributed to sepsis with superimposed hepatic encephalopathy, he was also diagnosed with meningitis. Cultures from the cerebral spinal fluid and blood serum were positive for Listeria monocytogenes. The patient’s family reported that he had not recently consumed deli meat, cheeses, or raw chicken, and there were no known outbreaks in the area at the time of diagnosis. CONCLUSIONS: This report illustrates a rare case of concurrent septicemia and meningitis secondary to Listeria monocytogenes in a patient with liver cirrhosis and reviews current literature.