Listeria Spinal Cord Abscess – Clinical and MRI Findings

Abstract

ABSTRACT:Background: Intramedullary spinal cord abscess due to Listeria Monocytogenes is an uncommon condition usually affecting immunocompromised patients. Method: Case study. Results: A 69-year-old man presented with 3 weeks history of subacute paralysis of both lower limbs and the left upper limb. Myelogram and CT scan showed a widened upper cervical cord. CSF revealed lymphocytosis, moderately elevated protein and depressed glucose. A gadolinium-enhanced MRI showed diffuse cervical cord edema with two ring-enhancing lesions at C2-C3. Blood and CSF cultures grew Listeria Monocytogenes. He received IV ampicillin and gentamycin; the latter was discontinued after 1 month due to nephrotoxicity. Serial MRI over the next 3 months showed significant reduction in the size of these abscesses. The patient made a modest improvement in the power of his lower limbs, however he remained bed-ridden. Aside from being a mild, diet-controlled diabetic, there was no evidence of immunosuppression. Conclusion: Listeria spinal cord abscess is a treatable disorder and should be considered in the differential diagnosis in patients with a subacute onset of spinal cord dysfunction. RESUME: Abces a Listeria de la moelle epiniere: observations cliniques et RMN. Introduction: L'abces intramedullaire du au Listeria monocytogenes est une condition rare qui atteint g6n6ralement les patients immunocompromis. Methode: Etude de cas. Resultats: Un homme ag6 de 69 ans s'est presente avec une histoire de paralysie subaigue des deux membres inferieurs et du membre sup6rieur gauche apparue trois semaines auparavant. Le myelogramme et le CT scan ont montr6 une moelle cervicale haute elargie. Le LCR a montre une lymphocytose, une eleVation modeY6e des proteines et un abaissement du glucose. Une RMN rehaussee au gadolinium a montre un oedeme diffus de la moelle cervicale avec deux lesions rehaussantes en anneaux au niveau de C2-C3. Des cultures du sang et du LCR ont revele la presence de Listeria monocytogenes. Le patient a regu de l'ampicilline et de la gentamycine IV, cette derniere medication ayant ete cessee apres un mois a cause de la n6phrotoxicite. La RMN s6riee sur une periode de 3 mois a montre une diminution significative de la taille de ces abces. La recuperation a ete minime et le patient est demeure' alite. Ce patient avait un diabete 16ger control^ par la diete. II n'avait pas d'evidence d'immunosuppression. Conclusions: L'abces spinal a Listeria est une maladie traitable et devrait etre considere dans le diagnostic diff6rentiel des patients qui ont une dysfonction de la moelle epiniere a d6but subaigu.

Listeria and Atypical Presentations of Listeria in the Central Nervous System

“…56 In a few cases MRI has nicely demonstrated spinal cord abscesses, which are typically cervical in location and multiple. 49 Histologic changes are similar to those seen in the brainstem with rhomboencephalitis. Focal small areas of hemorrhage are scattered throughout the affected area LISTERIA IN THE CENTRAL NERVOUS SYSTEM-BARTT…”

“…42,[46][47][48] A few additional cases were reported to be immunocompetent but did have other medical conditions such as "mild" diabetes mellitus or moderate alcohol use. 46,49 Age does not play a significant role in the development of cerebritis. Children and adults up to age 85 are affected, with a mean age of 48 years.…”

“…Half of the cases reported died as a result of listeriosis or at the time of their hospitalization. 49…”

“…Spinal cord abscess has been reported six times in the literature, with four of the six patients being reported as otherwise healthy. 49 The cervical or thoracic cord is affected as definable by clinical examination after a subacute history of progressive symptoms. 49…”

“…49 The cervical or thoracic cord is affected as definable by clinical examination after a subacute history of progressive symptoms. 49…”