1 - Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
2 - Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
3 - Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
4 - Pediatric Neurology Unit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
5 - Pediatric Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon.
- Excellence in Pediatrics, Prague. Poster Presentation.
Resume:
Introduction: Listeriosis is a severe and uncommon infectionwhich can invade tissues normally resistant to infection, such as the central nervous system, leading to life-threatening meningitis and encephalitis. Cellular immune response plays an important role in protective immunity.
Case Report: Ten year-old girl, from Sao Tome and Principe, with hepatic cirrhosis due to autoimmune hepatitis, under steroid treatment for the past three months, presented with a 4-day fever, headache, myalgias, cough, abdominal pain and diarrhea. The next day her condition worsened with altered mental status and meningeal signs. Blood culture was positive for Listeria monocytogenes and she was treated with ampicillin plus gentamicin, while maintaining steroid treatment. Lumbar puncture was not performed due to thrombocytopenia (27×109/L). EEG and Head-CT scan were normal, while MRI showed an enhancing micronodular lesion, in mammillary bodies with peripheral reinforcement and perilesional edema that was interpreted as a small abscess. She evolved favorably, with complete resolution of clinical and radiological signs and symptoms, having completed 31 days of IV ampicillin and 18 days of gentamicin. She was discharged on oral amoxicillin and maintained an outpatient follow-up.
Discussion: Listeriosis should be investigated in all patients with cellular immunosuppression who present febrile symptoms. The central nervous system may be the only area of the body infected and patients may present with focal neurological signs or disturbed states of consciousness. While brain abscess is rarely found, rhombencephalitis composes a rare but characteristic form of neurolisteriosis, as in our patient. The duration of therapy depends on the clinical syndrome, the presence of underlying disease and the response to treatment. Establishing suitable treatment as early as possible can improve the prognosis.
Palavras Chave: Brainabscess, immunosuppression, Listeriamonocytogenes