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First described by Murray in 1926, during an outbreak in rabbits in a Cambridge laboratory. <span class="elsevierStyleItalic">L. monocytogenes</span> is the only species of the genus Listeria known to be pathogenic to humans. They are gram-positive, facultative anaerobic, oxidase-negative, catalase-positive bacilli. They are usually found singly or in short chains and do not produce spores. They can grow and multiply under unfavourable conditions and are intracellular pathogens.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the case of a 71-year-old man, diagnosed with liver cirrhosis secondary to autoimmune hepatitis (AIH). The diagnosis was made during hospital admission for an AIH flare. He was discharged with treatment of methylprednisolone 48 mg/day in a tapering regimen. Fifteen days later, he presented to the emergency department with a deterioration of his general condition, progressive weakness, drowsiness, fever and an increase in the number of stools without pathological products. Physical examination showed fever of 38.5 °C, dysmetria and dysdiadochokinesia of the left upper limb, increased support base with Romberg and negative meningeal signs. Blood tests upon admission showed: WBC 13,270/mm<span class="elsevierStyleSup">3</span>; total bilirubin 4.77 mg/dl; GOT 161 U/L; GPT 434 U/L; GGT 182 U/L; 199 U/L alkaline phosphatase; procalcitonin 0.43 ng/ml and C-reactive protein 1.31 mg/dl. The cerebrospinal fluid obtained from the lumbar puncture was cloudy in appearance, with 506 WBC/mm<span class="elsevierStyleSup">3</span> (95% polymorphonuclear), glucose 143 mg/dl, total protein 232 mg/dl and lactate 10.8 mmol/l. <span class="elsevierStyleItalic">L. monocytogenes</span> isolates were found in blood cultures and cerebrospinal fluid. The study was completed with a brain MRI, which ruled out the presence of abscesses and changes in the posterior cranial fossa. With the diagnosis of bacteraemia and meningitis due to <span class="elsevierStyleItalic">L. monocytogenes</span>, the patient received parenteral treatment with ampicillin (37 days) and gentamicin (9 days, discontinued due to nephrotoxicity) with a good clinical-laboratory progression. As sequelae of meningitis, the patient developed communicating hydrocephalus after 2 months, which required the placement of an external ventricular drain, with subsequent resolution.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Listeriosis is a food-borne disease, which has been reported in isolated cases and outbreaks. An incidence of 3–6 cases per million inhabitants per year has been estimated, with a mortality of up to 20% in cases of central nervous system involvement. Risk factors include advanced age, pregnancy, diabetes, alcoholism, neoplasms and diseases related to cellular immunodeficiency, among others.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Patients with chronic liver disease are a risk group for invasive listeriosis, due to abnormalities in the innate immune system and due to dysfunction of neutrophils, especially in their phagocytic mechanism.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Cases of autoimmune hepatitis and listeriosis with central nervous system involvement (meningitis or brain abscesses) described in the literature are uncommon, but of particular interest because of their clinical and prognostic implication.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> Patients with AIH share 2 risk factors: underlying liver disease and immunosuppressive treatment, which call for a high clinical suspicion of this entity and early targeted treatment due to its high mortality rate.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ezquerra A, Martínez B, García-Buey L. Listeriosis invasiva en un paciente con hepatitis autoinmune en tratamiento con glucocorticoides. Med Clin (Barc). 2022;158:39.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Campylobacteriosis, salmonellosis, yersiniosis, and listeriosis as zoonotic foodborne diseases: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Chlebicz" 1 => "K. 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Shah" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2010.11.034" "Revista" => array:6 [ "tituloSerie" => "J Hepatol" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "574" "paginaFinal" => "581" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21236309" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Listeria monocytogenes meningitis in an immunosuppressed patient with autoimmune hepatitis and IgG4 subclass deficiency" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. 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Khedimi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.idcr.2019.e00569" "Revista" => array:5 [ "tituloSerie" => "ID Cases" "fecha" => "2019" "volumen" => "17" "paginaInicial" => "e00569" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31312600" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015800000001/v2_202201200752/S2387020621006665/v2_202201200752/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015800000001/v2_202201200752/S2387020621006665/v2_202201200752/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621006665?idApp=UINPBA00004N" ]
Journal Information
Vol. 158. Issue 1.
Pages 39 (January 2022)
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Vol. 158. Issue 1.
Pages 39 (January 2022)
Letter to the Editor
Invasive listeriosis in a patient with autoimmune hepatitis on glucocorticosteroid therapy
Listeriosis invasiva en un paciente con hepatitis autoinmune en tratamiento con glucocorticoides
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Alberto Ezquerra
, Belén Martínez, Luisa García-Buey
Corresponding author
Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, Spain
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