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Listeria Spinal Cord Abscess – Clinical and MRI Findings

  • Joseph Y. Chu (a1), Walter Montanera (a2) and Robert A. Willinsky (a2)

Abstract

Background : Intramedullary spinal cord abscess due to Listeria Monocytogenes is an uncommon condition usually affecting immunocompromised patients. Method : Case study. Results : A 69-year-old man presented with 3 weeks history of subacute paralysis of both lower limbs and the left upper limb. Myelogram and CT scan showed a widened upper cervical cord. CSF revealed lymphocytosis, moderately elevated protein and depressed glucose. A gadolinium-enhanced MRI showed diffuse cervical cord edema with two ring-enhancing lesions at C2-C3. Blood and CSF cultures grew Listeria Monocytogenes. He received IV ampicillin and gentamycin; the latter was discontinued after 1 month due to nephrotoxicity. Serial MRI over the next 3 months showed significant reduction in the size of these abscesses. The patient made a modest improvement in the power of his lower limbs, however he remained bed-ridden. Aside from being a mild, diet-controlled diabetic, there was no evidence of immunosuppression. Conclusion : Listeria spinal cord abscess is a treatable disorder and should be considered in the differential diagnosis in patients with a subacute onset of spinal cord dysfunction.

Résumé

Abcès à Listeria de la moelle épinière: observations cliniques et RMN. Introduction : L’abcès intramédullaire dû au Listeria monocytogenes est une condition rare qui atteint généralement les patients immunocompromis. Méthode : Étude de cas. Résultats : Un homme âgé de 69 ans s’est présenté avec une histoire de paralysie subaiguë des deux membres inférieurs et du membre supérieur gauche apparue trois semaines auparavant. Le myélogramme et le CT scan ont montré une moelle cervicale haute élargie. Le LCR a montré une lymphocytose, une élévation modérée des protéines et un abaissement du glucose. Une RMN rehaussée au gadolinium a montré un oedème diffus de la moelle cervicale avec deux lésions rehaussantes en anneaux au niveau de C2-C3. Des cultures du sang et du LCR ont révélé la présence de Listeria monocytogenes. Le patient a reçu de l’ampicilline et de la gen-tamycine IV, cette dernière médication ayant été cessée après un mois à cause de la néphrotoxicité. La RMN sériée sur une période de 3 mois a montré une diminution significative de la taille de ces abcès. La récupération a été minime et le patient est demeuré alité. Ce patient avait un diabète léger contrôlé par la diète. Il n’avait pas d’évidence d’immunosuppression. Conclusions : L’abcès spinal à Listeria est une maladie traitable et devrait être considéré dans le diagnostic différentiel des patients qui ont une dysfonction de la moelle épinière à début subaigu.

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Copyright

Corresponding author

Queensway General Hospital, 150 Sherway Drive. Etobicoke, Ontario, Canada M9C 1A5

References

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