Listeria rhombencephalitis in an alcoholic man; A case report and review of literature

Listeria infections are uncommon in our clinical practice and often overlooked as a differential diagnosis. It is also difficult to uncover due to presentation with a variety of non-specific clinical signs and symptoms, that could mimic other conditions. In our case report, we discuss a rare and challenging case of a middle-aged alcoholic man with Listeriosis affecting the rhombencephalon. He presented with non-specific symptoms, including agitation and confusion, preceded by flu-like illness. These were accompanied by seizures and fever in hospital, as well as intermittently changing neurological deficits. Although his symptoms were put down to alcohol withdrawal initially, the timely identification of Listeria monocytogenes in blood cultures could aid to point towards the correct diagnosis and hence prompt a lifesaving treatment. It was later confirmed with MRI imaging of the brain, showing inflammation around the brainstem. Lumbar puncture results were also alluding to a meningoencephalitis picture. Despite the high mortality rate, our patient survived and was discharged from hospital six weeks after the initial admission. We will compare our case with other case reports from the literature. Finally, the discussion will highlight the importance of considering Listeria when treating possible encephalitis/ meningitis in patients at risk. • Listeria monocytogenes causes fatal CNS infections, e.g. encephalitis. • Rhombencephalitis: inflammation of Brainstem and cerebellum (rhombencephalon). • At-risk group: immune compromised, elderly, neonates, pregnant women, alcoholics. • Diagnosis is rare, challenging, but serious and life threatening. • Needs high index of clinical suspicion, cultures, CSF analysis, MRI scan of brain.