A 64-year-old man with fever, nausea, vomiting, diarrhea and altered mental status was admitted to the infectious diseases unit. On physical examination, he had lethargy and acutely ill with a high fever (temperature 38℃), tachycardia and meningeal signs. The analysis of the CSF revealed a meningeal syndrome with increased levels of protein, pleocytosis with a predominance of PMNs. He had a history of chronic obstructive pulmonary disease. The CSF culture yielded serotype 4 L. monocytogenes. Two sets of blood cultures came out negative. He was treated with penicillin G (24MU/d for 14 days), and his condition transiently improved after administering the antibiotic treatment. The patient became afebrile and was discharged with a prescription for po ampicillin (4g/d) to complete a 21-day course of antibiotic therapy.
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.