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 28-year-old woman was admitted to the gynecology unit diagnosed with a recurrence of disgerminoma. Six months earlier, she had undergone total abdominal hysterectomy, bilateral salpingo-oophorectomy and cyto-reductive surgery for disgerminoma. After the surgery, she received radiotherapy and 4 sessions of chemotherapy. The last session of chemotherapy had ended 2 weeks ago. On day 4, the patient developed a fever (temperature 39.2℃), chills and sweats and was in poor condition in general. Two sets of blood cultures were positive for serotype 1 L. monocytogenes. The patient started receiving penicillin G (20MU/d). On day 6 of hospitalization, she became afebrile and her symptoms and findings progressively improved. Blood cultures that were taken within 3 days of therapy gave negative results for L. monocytogenes. She was discharged from the hospital on the 18th day and subsequently received ampicillin (4g/d) perorally for 7 days.