Castro Aracelly, Hernández Olga Helena, Uribe Carlos Santiago, Guerra Alejandro, Urueña Piedad
Departamento de Neurología, Universidad de Antioquia, Medellín, Colombia.
Unidad de Cuidados Intensivos Neurológicos, Instituto Neurológico de Colombia, Medellín, Colombia.
Biomedica. 2013 Jul-Sep;33(3):343-9.
Brainstem encephalitis caused by Listeria monocytogenes is an uncommon form of central nervous system listeriosis; however, it is the most common presentation in immunocompetent individuals. Here, we describe an even more rare combination of rhombencephalitis with severe myelitis caused by L. monocytogenes in an immunocompetent patient. We report the case of a 21-year-old immunocompetent patient who consumed unpasteurized dairy products and experienced headache and vomiting that progressed to an impaired general condition, altered consciousness and ultimately death. The patient had presented to the Neurological Institute of Colombia (INDEC in Spanish) for consultation and was diagnosed with brainstem encephalitis and myelitis caused by Listeria monocytogenes . The differences between this particular case and those reported in the literature will be discussed. It is advisable to initiate antibiotic treatment for Listeria monocytogenes if a patient shows signs of brainstem compromise of possible infectious origin and quickly intensify treatment if there is no or minimal response. It is also necessary to extend radiological assessment to include the spinal column to rule out spinal cord involvement.
由单核细胞增生李斯特菌引起的脑干脑炎是中枢神经系统李斯特菌病的一种罕见形式;然而,它是免疫功能正常个体中最常见的表现形式。在此,我们描述了一名免疫功能正常的患者中,由单核细胞增生李斯特菌引起的更为罕见的菱形脑炎合并严重脊髓炎的病例。我们报告了一名21岁免疫功能正常的患者,该患者食用了未经巴氏杀菌的乳制品,出现头痛和呕吐,病情进展为全身状况受损、意识改变,最终死亡。该患者曾到哥伦比亚神经研究所(西班牙语为INDEC)咨询,被诊断为单核细胞增生李斯特菌引起的脑干脑炎和脊髓炎。将讨论该特殊病例与文献报道病例之间的差异。如果患者出现可能由感染引起的脑干受损迹象,建议启动针对单核细胞增生李斯特菌的抗生素治疗,若没有反应或反应极小,则应迅速加强治疗。还需要扩大放射学评估范围以包括脊柱,以排除脊髓受累情况。