Intracranial Hemorrhage Associated With Listeria monocytogenes Bacteremia in an Elderly Patient on Mycophenolate Mofetil

Listeria monocytogenes is an important foodborne bacterial pathogen in immunosuppressed patients, pregnant women, and individuals at the extremes of age, including neonates and older adults. Invasion of the central nervous system (CNS) and bacteremia are the principal clinical manifestations of infection in these hosts. In contrast, normal hosts who ingest high numbers of Listeria may develop self-limited febrile gastroenteritis. Hydrocephalus and intracranial hemorrhage (ICH) are very rare and severe complications of L. monocytogenes infection. ICH associated with L. monocytogenes has been reported even less frequently than hydrocephalus, with most cases occurring in the pediatric population. In this paper, we present a case of L. monocytogenes bacteremia in a 71-year-old male, complicated by intracranial hemorrhage. He presented at first with nonspecific symptoms of generalized weakness and fatigability and later developed drowsiness, disorientation, and fever, which prompted further investigations that revealed the presence of ICH and L. monocytogenes bacteremia.