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 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.