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 36-year-old man with epistaxis, dyspnea, headaches, sore throat, fever (temperature 39.8℃), meningeal signs and lethargy was admitted to the infectious diseases unit. One month before admission, he had undergone a renal transplantation due to amiloidosis. At the time of admission, he received prednisolone, cyclosporine and ranitidine. Examination of CSF revealed pleocytosis with a predominance of PMNs. The CSF culture yielded serotype 4 of the L. monocytogenes. Despite treatment with ampicillin (12g/d) and netilmicin (300mg/d), the patient's condition detoriated rapidly, and he died after four days of therapy.