Hemorragic presentation of Listeria Monocytogenes rhombencephalic abscess

Main Article Content

Paola Feraco
Francesca Incandela
Flavia Stallone
Francesca Alaimo
Laura Geraci
Francesco Bencivinni
Giuseppe La Tona
Cesare Gagliardo

Keywords

Listeria monocytogenes, brain magnetic resonance imaging, MRI, hemorrhage, infectious disease

Abstract

Listeria monocytogenes (LM) bacterium is a cause of central nervous system (CNS) infection and the most common cause of rhombencephalitis in immunocompetent elderly. A prompt identification of this condition should be always desirable, since its clinical manifestations are often unspecific with prodromal symptoms leading to high rates of morbidity and mortality if underestimated. CNS listeriosis magnetic resonance imaging (MRI) findings are generally not specific. However, in the appropriate clinical setting, focal brainstem hyperintensity on T2-weighted pulse sequences associated with ring-enhancement pattern after i.v. contrast media injection should be suspicious of LM abscess. The diagnosis cannot exempt from anamnestic-clinical investigation data correlation to exclude mimicking. We report the case of a 72-year-old man with fever, headache, vomiting, and persistent hiccups with an increasing walking difficulty. A progressive worsening of the state of consciousness led him to a stupor state. Brain MRI examination detected multiple rhombencephalic abscesses. Among these, one was with atypical hemorrhagic presentation. The presence of hemorrhage, uncommon for listeria abscesses, may further complicate their detection, with consequent delayed treatment. The diagnostic hypothesis was confirmed by cerebrospinal fluid examination, which was confident with LM infection. Clinical and neuroradiological state improved after antibiotic therapy.

Abstract 277 | PDF Downloads 49 HTML Downloads 7 XML Downloads 0

References

1. Arslan F, Ertan G, Emecen AN, Fillatre P, Mert A, Vahaboglu H. Clinical presentation and cranial MRI findings of Listeria monocytogenes encephalitis: A literature review of case series. Neurologist. 2018;23:198–203. https://doi.org/ 10.1097/NRL.0000000000000212

2. Kayaaslan BU, Akinci E, Bilen S, et al. Listerial rhombencephalitis in an immunocompetent young adult. Int J Infect Dis. 2009;13(2):65–7. https://doi.org/10.1016/j.ijid.2008.06.026

3. Charlier C, Poirée S, Delavaud C, et al. Imaging of human neurolisteriosis: A prospective study of 71 cases. Clin Infect Dis. 2018;67(9):1419–26. https://doi.org/10.1093/cid/ciy449

4. Britt RH, Enzmann DR, Yeager AS. Neuropathological and computerized tomographic findings in experimental brain abscess. J Neurosurg. 1981;55:590–603. https://doi.org/10.3171/jns.1981. 55.4.0590

5. Schwartz KM, Erickson BJ, Lucchinetti C. Pattern of T2 hypointensity associated with ring-enhancing brain lesions can help to differentiate pathology. Neuroradiology. 2006;48:143–9. https://doi.org/10.1007/s00234-005-0024-5

6. Chawla S, Wang S, Mohan S, et al. Differentiation of brain infection from necrotic glioblastoma using combined analysis of diffusion and perfusion MRI. J Magn Reson Imaging. 2019;49:184– 94. https://doi.org/10.1002/jmri.26053

7. Smirniotopoulos Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. RadioGraphics. 2007;27(2):525–51. https://doi.org/10.1148/rg. 272065155

8. Pesaresi I, Sabato M, Desideri I, Puglioli M, Moretti P, Cosottini M. 3.0T MR investigation of CLIPPERS: Role of susceptibility weighted and perfusion weighted imaging. Magn Reson Imaging. 2013;31:1640–2. https://doi.org/10.1016/ j.mri.2013.06.012

9. Mortimer A, O’Leary S, Bradley M, Renowden SA. Pitfalls in the discrimination of cerebral abscess from tumour using diffusion-weighted MRI. Clin Radiol. 2010;65:488–92. https://doi. org/10.1016/j.crad.2009.12.012

10. Muccio CF, Esposito G, Bartolini A, Cerase A. Cerebral abscess and necrotic cerebral tumours: Differential diagnosis by perfusion-weighted magnetic resonance imaging. Radiol Med. 2008; 113:747–57. https://doi.org/10.1007/s11547-008-0254-9

11. Kang BK, Na DG, Ryoo JW, Byun HS, Roh HG, Pyeun YS. Diffusion-weighted MR imaging of intracerebral hemorrhage. Korean J Radiol. 2001;2(4):183–91. https://doi.org/10.3348/kjr. 2001.2.4.183

12. Hess A, Klein I, Iung B, et al. Brain MRI findings in neurologically asymptomatic patients with infective endocarditis. Am J Neuroradiol. 2013;34:1579– 84. https://doi.org/10.3174/ajnr.A3582

13. Gupta RK, Tomar V, Awasthi R, et al. T2*-weighted MR angiography substantially increases the detection of hemorrhage in the wall of brain abscess: Implications in clinical interpretation. Neuroradiology. 2012;54:565–72. https://doi. org/10.1007/s00234-011-0952-1

14. Chiang IC, Hsieh TJ, Chiu ML, et al. Distinction between pyogenic brain abscess and necrotic brain tumour using 3-tesla MR spectroscopy, diffusion and perfusion imaging. Br J Radiol. 2009 Oct;82:813– 20. https://doi.org/10.1259/bjr/90100265

15. Nham B, Baskin J, Choong H. Listeria rhomboen-cephalomyelitis complicated by hemorrhagic trans-formation. Neurology. 2017;89:872–3. https://doi. org/10.1212/WNL.0000000000004273

16. Wilson SL, Drevets DA. Listeria monocytogenes infection and activation of human brain microvascular endothelial cells. J Infect Dis. 1998;178: 1658–66. https://doi.org/10.1086/314490