A 63-year-old man was admitted to the infectious diseases unit with diarrhea, fever (temperature 39℃), chills, sweats and a poor condition in general. He had chronic renal failure due to amyloidosis and multiple myeloma (stage 2b). Ten days before admission, he had taken the last session of immunosuppressive therapy and ranitidine. Laboratory tests revealed a WBC count of 500/mm3 with 34% PMNs. His condition had been diagnosed as febril neutropenia. He was immediately admitted to the hematology unit and started receiving imipenem (1g/d; dose adjusted to his renal function). Blood cultures were positive for serotype 4 L. monocytogenes. The initial antibiotic therapy was continued, and amikacin (500mg/d) was added second days of therapy. Four days after the administration of imipenem, the patient became afebrile, and the laboratory tests showed an abatement of his neutropenia. On day 14, he was discharged with a 7-day prescription for po ampicillin/sulbactam (1250mg/d).
A 70-year-old man was hospitalized in the hematology unit, showing symptoms of fever (temperature 38℃) and night sweats. The patient, who was treated for acute myeloid leukemia and with his last chemotherapy having been 6 weeks ago, had pancytopenia (a WBC count of 400/mm3 with 20% PMNs). On day 3 of hospitalization, L. monocytogenes was cultured in blood samples. The therapy began with ampicillin (8g/d) and amikacin (1g/d). On day 9, his condition continued to detoriate. He developed orofaringeal candidiasis and laboratory findings revealed deep neutropenia (a WBC count of 100/mm3). Antibiotic therapy was continued and I.V. amphotericin B (1mg/kg/d) was added. Despite these therapies, he died on the 13th day of hospitalization.