Abstract
We present a rare case of Listeria monocytogenes (LM) rhombencephalitis with the formation of multifocal abscesses in a young immunocompetent
patient. His initial symptoms of dizziness, headache, and feeling generally unwell
were put down to a coincidental coinfection with severe acute respiratory syndrome
coronavirus 2 (SARS-CoV-2). The unfortunate rapid progression to trigeminal, hypoglossal,
vagal, facial, and abducens nuclei palsies, and then an acquired central hypoventilation
syndrome, known as Ondine's curse, required a prolonged intensive care unit (ICU)
stay, and prolonged mechanical ventilation. As they continued to deteriorate despite
targeted antibiotic treatment, surgical drainage of the abscesses was seen as the
only meaningful available treatment option left to contain the disease. Postoperatively,
the patient's strength rapidly improved as well as the severity of the cranial nerve
palsies. After prolonged rehabilitation, at 3 months of follow-up, the patient was
weaned off mechanical ventilation, independently mobile, and was left with only minor
residual neurologic deficits. This case highlights a number of interesting findings
only touched upon in current literature including the route of entry of LM into the
central nervous system, the rare entity of acquired central hypoventilation syndrome,
and finally the use of surgical intervention in cerebral LM infections.
Keywords
Listeria monocytogenes
- brainstem abscess - rhombencephalitis
