Listeria Monocytogenes Meningitis Presenting with Bilateral Abducens Nerve Palsy in a Patient with Systemic Lupus Erythematosus

You-mi Hwang; Seung-Ki Kwok; Ji-Min Kim; Ho-Sung Yoon; Ji Hyeon Ju; Kyung-Su Park; Sung-Hwan Park; Ho-Youn Kim

doi:10.4078/jkra.2009.16.4.333

Journal List > J Korean Rheum Assoc > v.16(4) > 1003696

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Hwang, Kwok, Kim, Yoon, Ju, Park, Park, and Kim: Listeria Monocytogenes Meningitis Presenting with Bilateral Abducens Nerve Palsy in a Patient with Systemic Lupus Erythematosus

Original Article

J Korean Rheum Assoc 2009;16(4):333-337.

Published online: 20 January 2009

DOI: https://doi.org/10.4078/jkra.2009.16.4.333

Listeria Monocytogenes Meningitis Presenting with Bilateral Abducens Nerve Palsy in a Patient with Systemic Lupus Erythematosus

You-mi Hwang, Seung-Ki Kwok, Ji-Min Kim, Ho-Sung Yoon, Ji Hyeon Ju, Kyung-Su Park, Sung-Hwan Park, Ho-Youn Kim

Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea

Received 10 August 2009 Revised 4 September 2009 Accepted 9 September 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.

Keywords: Systemic lupus erythematosus, Listeria monocytogenes, Meningitis, Neuropsychiatric lupus

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Fig. 1.

(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.

Fig. 2.

Light microscopic study shows the gram-positive cocco-rods that were documented as Listeria monocytogenes in a CSF culture study (Gram stain, ×1,000).

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