Invasive Listeriosis-Atypical Presentation with Delayed Diagnosis

Invasive listeriosis with brain infection remains a diagnostic challenge with an early treatment need to reduce morbidity and mortality. Not only is a foodborne pathogen with a rising incidence but also responsible for variable clinical manifestations with an initial extensive differential diagnosis to be considered. Imaging studies such as CT scan and MRI are helpful, but the former is frequently normal and the findings of the latter are only useful when it correlates with a suggestive medical history, physical exam and positive blood or cerebrospinal fluid cultures. We report a case of invasive listeriosis with concomitant lung and brain infection, whose uncommon presentation delayed prompt diagnosis of the latter. Our aim is to raise awareness for these atypical presentations since it is so difficult to identify Listeria infection and patient's outcome depends on early antibiotic treatment start.