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25 November 2022 : Case report  USA

[In Press] A Case Report of Listeria Meningitis with Severe Rhabdomyolysis and Normal Renal Function

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction

Mina Sourial1EF, Sumit Kapoor12EF, Manoj Karwa1EF

DOI: 10.12659/AJCR.938024

Am J Case Rep In Press; DOI: 10.12659/AJCR.938024  

Available online: 2022-11-25, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Listeria monocytogenes is known to cause meningitis, bacteremia, and rhabdomyolysis, typically associated with acute kidney injury. We present the case of a young woman who developed severe rhabdomyolysis without kidney failure in the setting of listeriosis.
CASE REPORT
A 22-year-old woman with a past medical history of type 1 diabetes mellitus presented with fever, headache, and vomiting. Initial blood work revealed a white blood cell count of 22 K/┬ÁL, creatine phosphokinase (CPK) level of 275 U/L, blood urea nitrogen of 9 mg/dL, and creatinine of 0.89 mg/dL. A lumbar puncture (LP) was performed and was positive for Listeria monocytogenes. Her initial point-of-care ultrasound demonstrated hyperdynamic left ventricular (LV) function. Although she was immediately started on empiric coverage for bacterial and viral meningitis with intravenous vancomycin, ceftriaxone, and acyclovir, the antimicrobial regimen was changed to ampicillin and gentamicin after the LP results were obtained. On the second hospital day, a repeat echocardiogram demonstrated a dilated LV with severely reduced function with an ejection fraction (EF) of 30%. Her CPK increased and peaked at 299 637 U/L by day 6. Despite the low EF and elevated CPK, her kidney function remained at baseline at all times. Her EF improved to 60% by hospital day 20. She received large volumes of intravenous fluids, completed a 3-week course of ampicillin, continued to improve, and was discharged to a rehabilitation facility with no deficits.
CONCLUSIONS
Listeria infection can be associated with severe rhabdomyolysis, which is usually associated with kidney dysfunction. Administration of large volumes of intravenous fluids may decrease this likelihood.

Keywords: Acute Kidney Injury; Listeria monocytogenes; Meningitis, Bacterial; Rhabdomyolysis

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923