Infection still remains a major cause of morbidity and mortality in systemic lupus erythematosus (SLE). Patients with SLE are well known to have an increased risk of various opportunistic infections, which can be fatal. Central nervous system (CNS) infections such as meningitis are rare complications to SLE. On occasion, nonspecific neurologic manifestations of infectious meningitis in SLE patients can be confused with neuropsychiatric lupus. Listeria monocytogenes is a less-commonly identified organism causing meningitis in SLE patients. Here, we describe a case of Listeria monocytogenes meningitis presenting with bilateral abducens nerve (sixth cranial nerve) palsy in a patient with SLE, who was successfully treated with systemic antibiotics.
(A) Bilateral abducens nerve palsy at the time of admission. The patient was not fully able to gaze laterally. The right image showed that the left abducens nerve was severely impaired at the time of admission. (B) Full recovery of bilateral gaze after treatment with antibiotics.
Light microscopic study shows the gram-positive cocco-rods that were documented as Listeria monocytogenes in a CSF culture study (Gram stain, ×1,000).