A 7-year-old previously healthy girl presented to an emergency department (ED) with one-day history of headaches. Symptoms progressed with worsening of headache, emesis and lack of responsiveness. She was transferred to a second ED for higher level of care, where a lumbar puncture was unsuccessful. She was started on antibiotics 24 hours after symptom onset and transferred to a Children’s Hospital.

Cerebrospinal fluid analysis (CSF) was consistent with lymphocytic predominant bacterial meningitis. Magnetic resonance imaging brain showed acute ischemia in left parieto occipital area and splenium of corpus callosum with no evidence of hydrocephalus.On day four of admission, patient became agitated with acute loss of consciousness, requiring intubation and mechanical ventilation. Computerized tomography (CT) scan of head showed new onset hydrocephalus involving the lateral and 3rd ventricles. Repeat CT head revealed progressive ventriculomegaly, which prompted transfer to our hospital for Neurosurgical evaluation. Patient underwent urgent external third ventriculostomy (EVD) placement. Repeat CSF during EVD placement was again consistent with bacterial meningitis. CSF culture (pretreated) at transfer was reported to be growing gram positive rods. As the initial CSF, and a repeat study from EVD was consistent with a bacterial meningitis with concerns for Listeria monocytogenes, high dose ampicillin in addition to  ceftriaxone and vancomycin was initiated. Repeat CSF and blood cultures confirmed Listeria monocytogenes. 

Interesting, patient loved eating a brand of cheese made outside USA. Parents reported that she may have consumed cheese sitting outside refrigerator for an unknown time duration.

Listeria monocytogenes is facultative anerobic, gram-positive, bacillus isolated from soil, vegetables, and wild or domestic animals. Listeria infection is usually found in newborns, elderly, in immunocompromised patients and pregnant women. It is extremely rare in immunocompetent children, and should be considered in patients with atypical lymphocytic meningitis.