A 48-year-old man with fever, nauseous, vomiting, and dizzy A CARE case report

Abstract

Rationale: Listeria monocytogenes (LM) is an important foodborne bacterium, and LM meningoencephalitis is rare in clinical practice, with poor prognosis in severe patients. It is prone to misdiagnosis in clinical practice. We first reported a case of severe LM meningoencephalitis with muscle lesions and evaluated the comprehensive condition. Patient concerns: A 48-year-old man had a fever and was admitted to the neurology department due to dizziness, nausea, and vomiting for 20 days. Diagnoses: LM meningoencephalitis complicated with muscle lesions. Interventions: We used moxifloxacin 0.4g, qd, meropenem 2g, q8h, and dexamethasone 10mg, qd to reduce exudation and adhesion. Then due to consideration of side effects, we increased the dose of ampicillin by 2g, q4h, stopped using meropenem and moxifloxacin, and turned to maintenance treatment with dexamethasone and ampicillin. We comprehensively managed his vital signs and physical organ functions, we also controlled some comorbidities. During the hospitalization period thereafter, we used intravenous anti-infection treatment with moxifloxacin 0.4g, qd, ampicillin 0.5g, q4h. Outcomes: Half a year later, the reexamination showed only protein elevation in cerebrospinal fluid and hydrocephalus in MRI. Afterward, the symptoms did not recur again. The patient recovered well after discharge. Lessons: LM meningoencephalitis complicated with lower limb muscle lesions is clinically rare. This report focuses on relevant treatment plans, which provide value for the examination and comprehensive management of patients with LM infection in the future. Abbreviations: CSF = cerebrospinal fluid, CT = computed tomography, DWI = diffusion weighted imaging, LM = Listeria monocytogenes, MRI = magnetic resonance imaging, NGS = next-generation sequencing, NRS = numerical rating scale, PAGI-SYM = patient assessment of gastrointestinal disorders-symptom severity index.