A Case Report of Listeria Meningitis with Severe Rhabdomyolysis and Normal Renal Function

Patient: Female, 22-year-old Final Diagnosis: Listeria bacteremia • Listeria meningitis • rhabdomyolysis Symptoms: Headache • nausea • vomiting Medication: — Clinical Procedure: Lumbar puncture Specialty: Critical Care Medicine • Infectious Diseases • Nephrology OBJECTIVE: Unusual clinical course BACKGROUND: Listeria monocytogenes is known to cause meningitis, bacteremia, and rhabdomyolysis, typically associated with acute kidney injury. We present the case of a young woman who developed severe rhabdomyolysis without kidney failure in the setting of listeriosis. CASE REPORT: A 22-year-old woman with a past medical history of type 1 diabetes mellitus presented with fever, headache, and vomiting. Initial blood work revealed a white blood cell count of 22 K/µL, creatine phosphokinase (CPK) level of 275 U/L, blood urea nitrogen of 9 mg/dL, and creatinine of 0.89 mg/dL. A lumbar puncture (LP) was performed and was positive for Listeria monocytogenes. Her initial point-of-care ultrasound demonstrated hyperdynamic left ventricular (LV) function. Although she was immediately started on empiric coverage for bacterial and viral meningitis with intravenous vancomycin, ceftriaxone, and acyclovir, the antimicrobial regimen was changed to ampicillin and gentamicin after the LP results were obtained. On the second hospital day, a repeat echocardiogram demonstrated a dilated LV with severely reduced function with an ejection fraction (EF) of 30%. Her CPK increased and peaked at 299 637 U/L by day 6. Despite the low EF and elevated CPK, her kidney function remained at baseline at all times. Her EF improved to 60% by hospital day 20. She received large volumes of intravenous fluids, completed a 3-week course of ampicillin, continued to improve, and was discharged to a rehabilitation facility with no deficits. CONCLUSIONS: Listeria infection can be associated with severe rhabdomyolysis, which is usually associated with kidney dys-function. Administration of large volumes of intravenous fluids may decrease this likelihood.