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 59-year-old man was admitted to the infectious diseases unit with a 2-day history of fever, altered mental status and headaches. He had a coronary heart disease. On admission to hospital the patient was afebrile. On day 2 of hospitalization, he developed a high fever (temperature 38.5℃) and meningeal signs. Examination of the CSF revealed a meningeal syndrome. The CSF culture yielded serotype 4 L. monocytogenes. The patient received penicillin G (24MU/d) and amikacin (1g/d) intravenously for 14-day. On day 6 of hospitalization, he became afebrile and his symptoms and findings gradually improved after administering of the therapy. The patient was diagnosed with diabetes mellitus. Antibiotic therapy continued with po ampicillin (4g/d) for 4 days, and then he was discharged.