A 62-year-old man with a history of diabetes mellitus, hepatic cirrhosis and congestive heart failure was admitted to the hospital. He was taking gliclazide, furosemide and digoxin He was admitted to the gastro-enterology unit with abdominal distention, ascites and edema on his feet. On day 12, he developed a fever, night sweats, chills, dyspnea and general malaise. His physical examination revealed a high fever (temperature 38.3℃) and tachycardia; blood and peritoneal fluid cultures were positive for serotype 4 L. monocytogenes. He underwent a course of treatment with intravenous penicillin G (24MU/d) and amikacin (1g/d) for 14 days. The patient's fever diminished after 3 days of therapy and he was discharged with a prescription of po ampicillin (4g/d) for 7 days.
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.