Case history

Case history

A 65-year-old man developed mental status changes, headache, fever, and increasing lethargy over a period of 2-3 days. The patient has a history of systemic lupus erythematosus and is taking 20 mg of prednisone daily. The patient's family reports that he had a brief gastrointestinal illness with diarrhoea that resolved 10 days prior to admission. They associated his illness with eating soft cheese and cold cuts. On admission the patient has a Glasgow coma score of 5/15, nuchal rigidity, and fever of 38.5°C (101.3°F).

Other presentations

Bacteraemia and sepsis are more common manifestations of listeriosis among immunocompromised patients, pregnant women, and neonates.[1][2][3][4] Infection can lead to localised manifestations such as splenic, renal, and hepatic abscesses; arthritis; conjunctivitis; and skin disorders.[1][2][5] Central nervous system (CNS) infection may cause brain abscesses, cranial nerve paralysis, seizures, movement disorders, and rhombencephalitis (brain stem encephalitis in healthy adults).[1][6][7][8] Bacteraemia may involve native or prosthetic valves.

Pregnant women may present with a flu-like illness.[2] Although bacteraemia is relatively common in pregnancy, CNS involvement is relatively uncommon. Listeriosis is associated with increased incidence of miscarriage.[2] Septic abortion due to granulomatosis infantiseptica (trans-placental transmission and disseminated micro-abscesses) is a serious complication.[2] Neonates may show very subtle signs and present without fever.[2]

Gastrointestinal symptoms of diarrhoea, nausea, and vomiting combined with fever may produce the clinical picture of febrile gastroenteritis due to contaminated food. This can occur sporadically or as an epidemic.[9] Untreated listeriosis may lead to disseminated intravascular coagulation, multiple organ dysfunction, shock, and death.[1]

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