A case of Listeria monocytogenes meningitis complicated by Hydrocephalus and Intraventricular hemorrhage: A review of treatment options and outcomes

Gerstein, Shawn; Gautam-Goyal, Pranisha; Goyal, Sameer

Our case is unique as the patient experienced two rare complications of neurolisteriosis: hydrocephalus and intraventricular hemorrhage both of which are associated with high morbidity and mortality, as well as lasting neurologic impairment. Despite these complications she did relatively well, regaining most of her functional status prior to discharge aside from some mild cognitive impairment. This could be influenced by multiple factors including the initiation of appropriate antimicrobials within 24 h of presentation, double coverage with an aminoglycoside as well as intraventricular administration, the placement of an EVD, steroids for the initial 5 days of hospitalization, and anti-seizure medications. As previously discussed, the data on the utility of steroids, dual antimicrobial coverage, and anti-epileptics in the setting of neurolisteriosis is conflicting, and there is no definitive evidence if it played a role in our patient's positive outcome. The utilization of a dose of an intrathecal aminoglycoside was relatively novel compared to other reported cases and merits further study as a potentially beneficial addition to standard therapy in this setting.