PP10.14 – 2620: An unusual presentation of Listeria meningitis in an immunocompetent child with selective spinal grey matter involvement

Objective Report an unusual case of Listeria meningitis in an immunocompetent child with selective spinal grey matter involvement. Methods Review of clinical records. Results A previously healthy 35 month-old girl presented back arching and neck stiffness in a context of fever and irritability. Listeria monocytogenes was confirmed by PCR on CSF and she was firstly treated with amoxicillin and gentamicin and then with ampicillin and amikacin. Five days after, she was transferred to PICU due to fluctuating GCS. CT scan revealed symmetrical hydrocephalus with herniation of tonsils through foramen magnum needing EVD insertion. At that time, a marked ependymal and leptomeningeal enhancement was seen in MRI head scan with contrast, as a pattern of meningitis with ventriculitis. MRI spine scan with contrast showed extensive whole grey matter signal changes, associated with loss of volume, consistent with myelomalacia, also anterior conus and ventral root enhancement of cauda equina, likely related to shunting. Clinically, she had mild hypotonia of the four limbs, developed bladder dysfunction, not being able to speak more than three words, not fixing nor following objects. EMG revealed acute inflammatory demyelinating polyneuropathy. She received intravenous immunoglobulin and corticoids, recovering gradually with improved responsiveness as well with mobility, being able sit with support. Conclusions Listeria monocytogenes causes 5% of neonatal meningitis (Heath, 2010) but is a rare cause in other ages, especially uncommon in immunocompetent patients. However, some cases of neurolisteriosis in immunocompetent children have been reported (Peer, 2010) with radiological findings as meningeal enhancement, ventriculitis and, less commonly, brain abscesses. Acute spinal symptoms are rare and spinal radiological findings (abscesses, arachnoiditis, and syringomyelia) are also uncommon. Selective grey matter involvement in spinal cord (parainfectious event or autoimmune response to infection) and features of peripheral demyelination on neurophysiological studies as in this case has not been reported before in children.