T. Rath, D. Budiman, M. Spieß

Abstract

Listeria are gram-positive bacteria and can cause life threatening infections in patients receiving immunosuppressive therapy. In patients after solid organ transplantation listeriosis is a rare complication in the first months of immunosuppressive therapy. Here we report on a case of listeria meningoencephalitis with lethal outcome in a renal transplant patient three years after transplantation.

Case report: A 67 year old female patient had been on hemodialysis for 13 months until she received a kidney transplant three years ago. Subsequently the patient suffered from recurrent urinary tract infections and detoriation of renal function. In addition there was a history of an infected large lymphocele, sigma diverticulitis and the detection of MRSA in a small decubital ulcer. On admission the patient presented with diarrhea, fever and signs of urinary tract infection with renal transplant dysfunction. Under the working diagnosis of urosepticaemia an antibiotic treatment with Laevofloxacin was started and the dehydration corrected. Because of the somnolent status of the patient a lumbal puncture was performed, leading to the diagnosis of encephalitis. In the initial blood culture there was growth of gram-positive rods, suggestive of Listeria bacteraemia. The urine culture yielded extended spectrum betalactamase producing Escherichia coli. The antibiotic therapy was adapted, immunosuppression was reduced and the patient improved. With the sudden development of generalized seizures she became dependent on mechanical ventilation. Treatment was further complicated by a pseudomonas wound infection and a candida albicans infected decubital ulcer. Nevertheless the patient could be stabilized and weaned from mechanical ventilation. However, the patient remained in coma and on dialysis and died 56 days after admission.

Key words: kidney, transplantation, listerai, meningoencephalitis, case report

Dr. Thomas Rath

Abteilung für Nephrologie und Transplantationsmedizin

Medizinische Klinik III

Westpfalz-Klinikum GmbH

Hellmut-Hartert-Str. 1

67655 Kaiserslautern

E-Mail: trath@bitte-keinen-spamwestpfalz-klinikum.de