A 56yo male with controlled DM, hyperlipidemia and GERD presented with nausea and vomiting, but over two days developed headache, dysphagia, and multiple cranial nerve deficits. Initial workup revealed a brainstem lesion with medullary swelling on MRI and showed a WBC of 6.7k that rose to 18.5k in a couple days. LP exhibited pleocytosis and positive PCR for Listeria monocytogenes. Already receiving vancomycin and piperacillin-tazobactam for pneumonia and steroids for brainstem swelling, ampicillin was added. Despite this, he continued to decline neurologically, and MRI later identified the development of multiple brainstem abscesses deemed too high risk for surgical drainage. The patient required prolonged mechanical ventilation, tracheostomy, and PEG tube placement but did stabilize. On further questioning, his wife reported recent consumption of Boar’s Head deli meat.
This case occurred in July of 2024 during a national Listeria outbreak linked to deli meats, which usually causes self-limiting gastrointestinal symptoms in healthy individuals.1 However, as demonstrated here, relatively healthy individuals can rarely develop severe complications such as rhombencephalitis. The further development of an abscess in this setting is even less common and more often develops in the cerebral hemispheres.2-4 As in our case, the few detailed case reports of Listeria brainstem abscesses in the literature all reported significant complications and need for intensive multidisciplinary care. Our patient’s neurological status slowly improved after prolonged ICU care, though full recovery has not yet been achieved.