Gaini Shahin, Karlsen Gunn Hege, Nandy Anirban, Madsen Heidi, Christiansen Debes Hammershaimb, Á Borg Sanna
Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, 100 Tórshavn, Faroe Islands ; Infectious Diseases Research Unit, Odense University Hospital and University of Southern Denmark, 5000 Odense, Denmark ; Department of Science and Technology, University of the Faroe Islands, 100 Tórshavn, Faroe Islands.
Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, 100 Tórshavn, Faroe Islands.
Case Rep Neurol Med. 2015;2015:248302. doi: 10.1155/2015/248302. Epub 2015 Dec 1.
A previously healthy 74-year-old Caucasian man with penicillin allergy was admitted with evolving headache, confusion, fever, and neck stiffness. Treatment for bacterial meningitis with dexamethasone and monotherapy ceftriaxone was started. The cerebrospinal fluid showed negative microscopy for bacteria, no bacterial growth, and negative polymerase chain reaction for bacterial DNA. The patient developed hydrocephalus on a second CT scan of the brain on the 5th day of admission. An external ventricular catheter was inserted and Listeria monocytogenes grew in the cerebrospinal fluid from the catheter. The patient had severe neurological sequelae. This case report emphasises the importance of covering empirically for Listeria monocytogenes in all patients with penicillin allergy with suspected bacterial meningitis. The case also shows that it is possible to have significant infection and inflammation even with negative microscopy, negative cultures, and negative broad range polymerase chain reaction in cases of Listeria meningitis. Follow-up spinal taps can be necessary to detect the presence of Listeria monocytogenes.
一名既往健康、对青霉素过敏的74岁白种男性因逐渐出现的头痛、意识模糊、发热和颈部强直入院。开始使用地塞米松和头孢曲松单药治疗细菌性脑膜炎。脑脊液细菌显微镜检查呈阴性，无细菌生长，细菌DNA聚合酶链反应阴性。入院第5天脑部第二次CT扫描显示患者出现脑积水。插入了一根外部脑室导管，导管内脑脊液中培养出单核细胞增生李斯特菌。患者出现了严重的神经后遗症。本病例报告强调了在所有疑似细菌性脑膜炎且对青霉素过敏的患者中经验性覆盖单核细胞增生李斯特菌的重要性。该病例还表明，在李斯特菌脑膜炎病例中，即使显微镜检查、培养和广泛聚合酶链反应均为阴性，仍可能存在严重感染和炎症。可能需要进行后续腰椎穿刺以检测单核细胞增生李斯特菌的存在。
