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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1692-1693

A Rare Case of Cerebellar Abscess due to Listeria Monocytogenes in an Elderly Patient with Ulcerative Colitis


1 Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
2 Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India
3 Department of Imaging Sciences and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Thiruvananthapuram, Kerala, India

Date of Submission05-Sep-2019
Date of Decision01-Oct-2019
Date of Acceptance24-Oct-2019
Date of Web Publication30-Aug-2022

Correspondence Address:
Kavita Raja
Department of Microbiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), (An Institution of National Importance under Govt. of India), Thiruvananthapuram - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355159

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How to cite this article:
Ponnambath DK, Kaviyil JE, Raja K, Abraham M, Thomas B. A Rare Case of Cerebellar Abscess due to Listeria Monocytogenes in an Elderly Patient with Ulcerative Colitis. Neurol India 2022;70:1692-3

How to cite this URL:
Ponnambath DK, Kaviyil JE, Raja K, Abraham M, Thomas B. A Rare Case of Cerebellar Abscess due to Listeria Monocytogenes in an Elderly Patient with Ulcerative Colitis. Neurol India [serial online] 2022 [cited 2022 Oct 7];70:1692-3. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1692/355159




Sir,

The characteristic feature of Listeria brain abscess is that it commonly affects the subcortical gray matter of the thalamus, midbrain, and pons. This feature is rare in brain abscess caused by other bacteria. Listeria causing cerebellar abscess is extremely rare. There are only 3 reported cases of Listeria cerebellar abscess, of which 1 has been from a patient with inflammatory bowel disease (IBD). Here, we report a case of Listeria brain abscess affecting the cerebellum in an elderly female patient with ulcerative colitis on azathioprine.

The patient was a 79-year-old female with ulcerative colitis presented with acute onset of giddiness, which was preceded by low-grade fever and watery diarrhea, 3 days prior. Due to flare-up of symptoms of ulcerative colitis and to maintain remission, the patient was started on oral azathioprine, 1 month prior to her presentation. There was no history of nausea, vomiting, altered consciousness, seizures, weakness, sensory or autonomic nervous system disturbances, or features of cranial nerve palsy. The magnetic resonance imaging (MRI) findings are described in [Figure 1]. A diagnosis of pyogenic cerebellar abscess was arrived with the radiological findings and the abscess was surgically drained. Gram staining and culture characteristics are shown in [Figure 2]. The identification was confirmed as Listeria monocytogenes by FilmArray® Meningitis/Encephalitis (ME) panel (BioFireTM Diagnostics, USA) in abscess pus and subsequently the culture isolate in VITEK 2 compact system (bioMerieux, France). The isolate was susceptible in vitro to penicillin (MIC-0.19 μg/ml), ampicillin (MIC <2 μg/ml), gentamicin (MIC <0.6 μg/ml), and cotrimoxazole. Oral azathioprine was discontinued and the patient was started on intravenous ampicillin for 6 weeks and gentamicin for the first 2 weeks. After 2 weeks, intravenous gentamicin was replaced with oral cotrimoxazole. Repeat MRI after the treatment course showed completely resolved lesion in the left cerebellum.
Figure 1: Axial T2-weighted MRI imaging showed left cerebellar hemispheric lesion with mass effect (a). Contrast-enhanced T1-weighted image shows peripheral thin irregular rim enhancement (b). Diffusion-weighted imaging (DWI) (c) and apparent diffusion coefficient (ADC) (d) images showed central diffusion restriction within the lesion

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Figure 2: Gram staining of cerebellar abscess pus showing numerous pus cells and short, nonbranching Gram-positive bacilli (Pointed with black arrows) Magnification—1000× (a), Growth of colonies of Listeria monocytogenes on 5% sheep blood agar (Inner Box—showing narrow zone of β-hemolysis under transmitted light) (b)

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The involvement of cerebellum is seen in 4–12% of total cases of brain abscesses and it usually denotes a contiguous otogenic or mastoid infection. Listeria causing abscess in the cerebellum is extremely rare. Currently, there are very few reported cases of cerebellar abscess caused by Listeria.[1],[2] Invasive listeriosis has been previously reported in very few cases of IBD treated with infliximab and azathioprine.[3],[4] When patients with IBD are started on immunomodulators or biological agents, avoidance of consumption of soft cheese, unpasteurized dairy products, undercooked processed meat delicacies, and cold-stored fruit salads should be advised to prevent occurrence of this CNS complication.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Choudhury N, Khan AB, Tzvetanov I, Garcia-Roca R, Oberholzer J, Benedetti E, et al. Cerebellar abscess caused by Listeria monocytogenes in a liver transplant patient. Transpl Infect Dis 2013;15:E224-8.  Back to cited text no. 1
    
2.
Tourret J, Benabdellah N, Drouin S, Charlotte F, Rottembourg J, Arzouk N, et al. Unique case report of a chromomycosis and Listeria in soft tissue and cerebellar abscesses after kidney transplantation. BMC Infect Dis 2017;17:288.  Back to cited text no. 2
    
3.
Inoue T, Itani T, Inomata N, Hara K, Takimoto I, Iseki S, et al. Listeria monocytogenes septicemia and meningitis caused by listeria enteritis complicating ulcerative colitis. Intern Med Tokyo Jpn 2017;56:2655-9.  Back to cited text no. 3
    
4.
Koklu H, Kahramanoglu Aksoy E, Ozturk O, Gocmen R, Koklu S. An unusual neurological complication in a patient with ulcerative colitis. Turk J Gastroenterol 2017;28:137-9.  Back to cited text no. 4
    


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