Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis

Background: Listeria monocytogenes is an opportunistic pathogen that causes severe infections of the Central Nervous System, such as meningitis or meningoencephalitis, and brain abscesses. Abscesses account for approximately 1-10% of CNS listerial infections and are observed in 1% of all listerial infections.

Methods: We describe a case of 70-year-old male patient who had several admissions in different hospitals over the last 8 weeks.

Results: He suffered from intermittent fever for over a month, recurrent episodes of headaches, disorientation and other neurological symptoms. His condition was misdiagnosed as giant cell arteritis and initially the patient was started on corticosteroids. MRI of the brain revealed the presence of multiple brain abscesses and the cerebrospinal fluid study confirmed the presence of Listeria Monocytogenes. The patient was started on ampicillin and he completed a 6 weeks' course of treatment.

Conclusions: This case emphasizes the need to include rare pathogens in the differential diagnosis when possible CNS infections are involved, as well as to show that in many cases some auto-immune diseases are overdiagnosed.

Keywords: Listerial infection of CNS; brain abscess; cerebritis; listeriosis.