Pyogenic Ventriculitis Caused by Listeria Monocytogenes

Abstract

Computed tomography (CT) of the brain at the time of admission was normal, except for a large left frontal sequela. A few hours later, his condition deteriorated, with onset of generalized seizures and loss of consciousness. Meningitis was highly suspected and therefore, lumbar puncture was performed. Cerebrospinal fluid (CSF) analysis showed pleocytosis (2080 cells/mm³, 88% of polymorphs) and increased protein levels (4.36 g/L [0.1-0.45]), which confirmed the diagnosis of bacterial meningitis. Listeria monocytogenes was cultured from the CSF and blood samples, resulting in intravenous Amoxicillin treatment. Due to the lack of clinical improvement, brain magnetic resonance imaging (MRI) was performed and revealed hyperintense debris in the occipital horns on diffusionweighted images (DWI, Figure 1A) with reduced apparent diffusion coefficient (ADC, Figure 1B). These ventricular sediments were slightly hypointense on T2-weighted images (T2WI, Figure 2A) and on fluidattenuated inversion recovery (FLAIR, Figure 2B). MRI showed a bright spot in the subarachnoid space of the right parietal region on DWI (Figure 3B) appearing slightly hypointense on FLAIR (Figure 3A). There was no ependymal enhancement nor meningeal thickening on gadolinium enhanced T1-weighted images. Final diagnosis was pyogenic ventriculitis (PV) and meningitis.

Pearls & Oy-sters: Diagnosis and Subtyping of Listeria Ventriculitis in an Immunocompetent Host

“…4 Ventriculitis, more commonly seen in postneurosurgery patients such as those with ventricular indwelling devices, may occur as a rare complication of meningitis. One case of Listeria ventriculitis has been reported in a 78-year-old immunocompetent patient 6 and other cases in pediatric patients or neonates. However, ventriculitis by itself is not specific or unique to neurolisteriosis; thus, our initial empiric antibiotic coverage consisted of IV vancomycin and a third-generation cephalosporin, 7,8 which does not cover Listeria .…”