We present the rare case of a 51-year old patient with progressive right sided
hemiparesis caused by a
cerebral abscess due to Listeria monocytogenes
infection. The initially suspected
cerebral ischemia or
bleeding was ruled out. Magnetic resonance imaging led to the suspected diagnosis of an angiocentric
lymphoma. An open cerebral biopsy revealed an intracranial
abscess formation. After
abscess evacuation and identification of Listeria monocytogenes, anti-infective treatment with
ampicillin and
gentamicin was started. After repeated cerebral imaging with signs of ongoing tissue
inflammation after 6 weeks we chose to prolong the
therapy with oral
amoxicillin until resolution of signs of intracerebral
inflammation after 12 weeks, documented by repeated cerebral magnetic resonance imaging. During hospitalization, the patient was diagnosed with
diabetes mellitus type II and treatment was initiated. The patient was discharged without any persistent
neurologic deficits.
Discussion: For the treatment of bacterial
brain abscesses, 4-6 weeks of intravenous antimicrobial treatment after surgical drainage are recommended. However, first line
therapy of invasive cerebral
listeriosis is not well established. We decided to use a combined treatment using
ampicillin and
gentamicin, followed by prolonged oral treatment due to ongoing tissue
inflammation.
Conclusion: No evidence-based treatment recommendations are available for
brain abscess caused by Listeria monocytogenes. We report a case with favorable outcome after anti-infective
ampicillin- and
gentamicin-based
therapy. Systematic assessment of treatment would be desirable.