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Título

Transverse myelitis associated with neurolisteriosis: a case-based update

RESUMO

CASE PRESENTATION: A 68-year-old man was admitted with a case of suspected chronic lymphocytic leukemia, due to leukocytosis with a lymphocytic predominance. He started investigation for further treatment in 2020, losing follow-up in the pandemic. 2 years after, the patient reported two episodes of falls. In the first, he reported a fall from a “water truck”, with pain and swelling in the left knee, but without trauma or excoriation. A week after this event, he fell off the hammock reporting severe pain in the lumbar region, being medicated, but always with the pain returning after the medication ceased its effects. From the second fall, on the following day, the condition evolved with paresis and hypoesthesia in the left lower limb. On this same day, evolving with involvement in the right lower limb. He was referred to the reference hospital in the region, already with a condition of grade 1 paraplegia and loss of sensitivity at the T10-T11 level. For investigation of the condition, a lumbar puncture was performed, the analysis of cerebrospinal fluid showed a yellow and turbid aspect. Then, antimicrobial treatment was performed with subsequent confirmation of infection by Listeria monocytogenes. After imaging tests, myelitis was suspected, which was associated with the bacterial infection.
DISCUSSION: Listeria monocytogenes is a gram-positive bacteria commonly transmitted by ingestion of poorly washed or undercooked food, via the fecal-oral route. This type of bacteria has a certain affinity with the central nervous system, affecting mostly neonates, pregnant women, elderly, and immunocompromised patients. Neurolisteriosis can occur in two ways, through a retrograde neural (associated with rhombencephalitis) or a hematogenous route (resulting in meningoencephalitis). Neurolisteriosis is an uncommon occurrence, but its association with myelitis resulting in a spinal cord syndrome is rare, even in cases with risk factors, such as possible immunosuppression caused by leukemia in the present case, with meningeal involvement being more common.
FINAL COMMENTS: Neurolisteriosis is a rare event which may be associated with myelitis, and such an association should be suspected, especially in patients at risk for infection. Its treatment should be initiated quickly, due to its high mortality rate.

Palavras Chave

Listeria monocytogenes, myelitis, liquor