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 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.