Background:
Listeria monocytogenes in a intramedullary spinal cord abscess is rare. Its presentation could mimic autoimmune or neoplastic disorders, causing diagnostic delays. This case shows clinical reasoning and diagnostic challenges in distinguishing infection from inflammatory causes of myelitis and in identifying rare pathogens.
Design/Methods:
A 70-year-old female with diabetes well controlled on insulin, prior cervical fusion, not on immunosuppressant medications, was admitted for neck pain and left arm weakness. One month before she was admitted for watery diarrhea and treated with ciprofloxacin without any neurological abnormality. This time, she came with severe left upper extremity weakness and sensory loss, no spinal tenderness. MRI imaging shows diffuse cervical cord edema and rim-like enhancement from C4–T1. CSF shows lymphocytic pleocytosis with elevated protein. Cultures and PCR were negative as well as pathology for malignant cells. The patient continued to have worsening left upper extremity pain and weakness despite being treated with dexamethasone injection. Autoimmune myelitis, lymphoma, and infection are three possible differential diagnoses. Biopsy is favored due to deterioration of the patients.
Results:
She underwent C3-C6 laminectomy, revealing purulent material in the cord. Operative cultures grew Listeria monocytogenes sensitive to ampicillin. She completed 6 weeks of ampicillin with residual weakness and numbness of her left hand. She then otherwise made a full recovery afterward.
Conclusions:
Listeria, even rare in intramedullary spinal cord, should be considered in older patients presenting with unexplained myelitis and a history of recent infection, like gastrointestinal illness, even if the CSF is negative. Invasive investigation should be considered, weighing the risks and benefits, in situations where the diagnostic yield is low and clinical deterioration persists, to define diagnosis and treatment timely.
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