A 70-year-old man was hospitalized in the hematology unit, showing symptoms of fever (temperature 38℃) and night sweats. The patient, who was treated for acute myeloid leukemia and with his last chemotherapy having been 6 weeks ago, had pancytopenia (a WBC count of 400/mm3 with 20% PMNs). On day 3 of hospitalization, L. monocytogenes was cultured in blood samples. The therapy began with ampicillin (8g/d) and amikacin (1g/d). On day 9, his condition continued to detoriate. He developed orofaringeal candidiasis and laboratory findings revealed deep neutropenia (a WBC count of 100/mm3). Antibiotic therapy was continued and I.V. amphotericin B (1mg/kg/d) was added. Despite these therapies, he died on the 13th day of hospitalization.
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.