SHM Converge Scientific Abstract ePoster Gallery-Listeria Meningitis Associated Third Nerve Palsy in a Healthy 26-Year-Old Male

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This case describes a healthy 26-year-old man who developed severe Listeria monocytogenes meningitis, an uncommon diagnosis in immunocompetent young adults. He initially presented with two days of high fever, myalgias, confusion, and lethargy. Because community-acquired meningitis in healthy adults is usually treated empirically with ceftriaxone and vancomycin, he did not initially receive Listeria coverage.<br /><br />Despite treatment, his mental status rapidly worsened and he required intubation. He then developed left anisocoria with a dilated, unresponsive pupil, consistent with a pupil-involving third nerve palsy. CSF and blood cultures later grew Listeria monocytogenes, and therapy was changed to ampicillin and gentamicin. He improved clinically and had no major cognitive or motor deficits, but persistent neurologic sequelae remained, including anisocoria, ptosis, horizontal diplopia, and mild hearing loss. He was discharged to complete four weeks of ampicillin. No source of infection was identified.<br /><br />The case highlights that Listeria is a rare but potentially devastating cause of meningitis even in healthy young adults, and that standard empiric regimens may miss it. The resulting delay in appropriate treatment can lead to complications such as cranial nerve injury, increased morbidity, and possibly mortality. The authors note that third nerve palsy associated with Listeria meningitis in healthy adults is especially rare, and long-term recovery of visual deficits is not well documented.<br /><br />Overall, the report emphasizes maintaining suspicion for Listeria meningitis in atypical cases of bacterial meningitis, even when classic risk factors are absent.

Asset Subtitle

Adam Zimilover

Meta Tag

Author List Adam Zimilover, Samantha Goldburg

Category Clinical Vignettes

Concept Listeria monocytogenes

Concept Community-Acquired Meningitis

Concept Empiric Therapy

Concept Altered Mental Status

Concept Cranial Nerve III Compression

Distinguished Non-Finalist

Presenter Organization Zucker School of Medicine at Hofstra University

Presenting Author Adam Zimilover

Track Adult

Keywords

Listeria monocytogenes

meningitis

healthy young adult

third nerve palsy

anisocoria

ampicillin

gentamicin

cranial nerve injury

bacterial meningitis

immunocompetent

Listeria monocytogenes

Community-Acquired Meningitis

Empiric Therapy

Altered Mental Status

Cranial Nerve III Compression