Listeria Meningitis — SCE Rheumatology MCQ

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HardRheumatology EmergenciesListeria MeningitisSCE Rheumatology

A 50-year-old woman with SLE on Mycophenolate and Prednisolone develops acute severe headache fever and neck stiffness. CT head is normal. LP shows neutrophilic pleocytosis elevated protein and low glucose. Gram stain shows Gram-positive rods. What is the most likely organism?

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Correct answer: D — Listeria monocytogenes

Gram-positive rods in the CSF of an immunosuppressed patient strongly suggest Listeria monocytogenes meningitis. Listeria is an important cause of meningitis in immunosuppressed patients, the elderly, and pregnant women. Treatment requires IV Amoxicillin (or Ampicillin) plus Gentamicin, as Cephalosporins do not cover Listeria. This should be considered when choosing empiric antibiotics for meningitis in immunosuppressed patients (Amoxicillin should be added to the standard regimen). Immunosuppression review is also essential.

Reference: NICE CG102 Bacterial meningitis; BSR biologic safety guidelines