A case report of diffuse intra-abscess hemorrhage in Listeria monocytogenes rhombencephalitis and its implications for early diagnosis and therapeutic monitoring

Abstract

We report a 74-year-old female presenting with fever, right eyelid ptosis, and peripheral facial palsy following dental treatment, who was initially misdiagnosed as acute brainstem infarction based on MRI showing T2-hyperintense signal in the right pons with restricted diffusion. Despite dual antiplatelet therapy and empiric antibiotics, brainstem dysfunction worsened. Serial MRI revealed lesion expansion, multifocal “worm-like” abscesses formation, nodular satellite lesions, and diffuse intra-abscess hemorrhage. Cerebrospinal fluid metagenomic next-generation sequencing (mNGS) identified Listeria monocytogenes. This case highlights the sequential MRI evaluations’ pivotal role in detecting early signs of Listeria CNS infection and disease progression, thereby facilitating timely adjustments to the therapeutic strategy.