Prolonged dysphagia due to Listeria-rhombencephalitis with brainstem abscess and acute polyradiculoneuritis

We report a case of previously healthy student with acute rhombencephalitis and brainstem abscess caused by Listeria monocytogenes. The disease begun with uncharacteristic prodromal symptoms of gastrointestinal infection followed by headache and vertigo. After hospital admission the patient rapidly...

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Bibliographic Details
Published in:The Journal of infection 2006-06, Vol.52 (6), p.e165-e167
Main Authors: Smiatacz, Tomasz, Kowalik, Maciej Michal, Hlebowicz, Maria
Format: Article
Language:English
Subjects:
Acute polyradiculoneuritis
Adult
Ampicillin - administration & dosage
Anti-Bacterial Agents - administration & dosage
Brain Abscess - etiology
Brain Stem - pathology
Brainstem abscess
Deglutition Disorders - etiology
Dysphagia
Encephalitis - complications
Encephalitis - diagnosis
Encephalitis - drug therapy
Gentamicins - administration & dosage
Humans
Listeria monocytogenes
Listeriosis - complications
Listeriosis - diagnosis
Listeriosis - drug therapy
Male
Polyradiculoneuropathy - etiology
Respiration, Artificial
Respiratory Insufficiency - etiology
Respiratory Insufficiency - therapy
Rhombencephalitis
Treatment Outcome
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Summary:We report a case of previously healthy student with acute rhombencephalitis and brainstem abscess caused by Listeria monocytogenes. The disease begun with uncharacteristic prodromal symptoms of gastrointestinal infection followed by headache and vertigo. After hospital admission the patient rapidly deteriorated, presenting pronounced dysphagia and respiratory failure requiring mechanical ventilation. The diagnosis was established upon clinical symptoms of infection, brainstem involvement, typical MRI findings and positive for L. monocytogenes blood culture. Infection was complicated by acute, demyelinating neuropathy, diagnosed upon clinical symptoms of frail palsy confirmed by ENG. Initially introduced empirical doxycyclin/ceftriaxon treatment was subsequently changed to targeted ampicillin/gentamycin therapy, mechanical ventilation, intravenous human immunoglobulin treatment, tracheostomy and endoscopic gastrostomy. Prolonged dysphagia resolved after rehabilitation. After one year the patient remains well with only slight dysmetria.
ISSN:0163-4453
1532-2742
DOI:10.1016/j.jinf.2005.08.034