A 42-year-old man was admitted to the dermatology unit because of pemphigus vulgaris. He was being treated with methylprednisolone, ranitidine and hydrotalcid. On day 43 of admission, meningoencephalitis occurred, characterized by a sudden onset of fever (temperature 39.2℃), meningeal signs and disturbances of consciousness. The meningeal syndrome was associated with purulent CSF pleocytosis with a predominance of polymorphonuclear leukocytes (PMNs). He was transferred into the infectious diseases unit. The CSF culture was positive for serotype 1 of the L. monocytogenes. Blood cultures were negative. A combination of penicillin G (20MU/d) and amikacin (1g/d) was administered to the patient. The patient's condition began to deteriorate despite intensive supportive therapy and he died on the fourth day of the antibiotic therapy.
A 57-year-old man with a history of chronic lymphocytic leukemia and hepatic cirrhosis with a positive serology for the hepatitis C virus was brought to the hospital with a fever (temperature 38.5℃), chills, night sweats, headaches, cough and anorexia. He was empirically treated with I.V. ampicillin/sulbactam (6g/d) and amikacine (1g/d). Two separate blood specimen cultures, drawn over 72 hours, yielded serotype 4 L. monocytogenes. The antibiotic therapy continued for 14 days. The patient's condition gradually improved with antibiotic therapy. When discharged, he was advised to take oral ampicillin/sulbactam (1,5g/d) for an additional 5 days.