背景:单核细胞增生李斯特菌(LM)是一种重要的食源性细菌,LM脑膜脑炎在临床实践中很少见,重症患者预后不良。临床上易出现误诊。我们首先报告了1例伴有肌肉病变的严重LM脑膜脑炎,并评估了综合病情。
方法:一名48岁男子因头晕发烧入院神经科,恶心,呕吐20天。
方法:LM脑膜脑炎并发肌肉病变。
方法:我们使用莫西沙星0.4g,qd,美罗培南2克,q8h,和地塞米松10毫克,qd以减少渗出和粘附。然后由于副作用的考虑,我们增加了2克氨苄青霉素的剂量,q4h,停止使用美罗培南和莫西沙星,并转向地塞米松和氨苄青霉素的维持治疗。我们全面管理他的生命体征和身体器官功能,我们还控制了一些合并症。在此后的住院期间,我们使用莫西沙星0.4g静脉抗感染治疗,qd,氨苄青霉素0.5g,q4h.
结果:半年后,MRI复查仅显示脑脊液蛋白升高和脑积水。之后,症状没有再复发。患者出院后恢复良好。
结论:LM脑膜脑炎合并下肢肌肉病变临床罕见。本报告重点介绍相关治疗方案,为今后LM感染患者的检查和综合管理提供了价值。
BACKGROUND: Listeria monocytogenes (LM) is an important foodborne bacterium, and LM meningoencephalitis is rare in clinical practice, with poor prognosis in severe patients. It is prone to misdiagnosis in clinical practice. We first reported a case of severe LM meningoencephalitis with muscle lesions and evaluated the comprehensive condition.
METHODS: A 48-year-old man had a fever and was admitted to the neurology department due to dizziness, nausea, and vomiting for 20 days.
METHODS: LM meningoencephalitis complicated with muscle lesions.
METHODS: We used moxifloxacin 0.4 g, qd, meropenem 2 g, q8h, and dexamethasone 10 mg, qd to reduce exudation and adhesion. Then due to consideration of side effects, we increased the dose of
ampicillin by 2 g, q4h, stopped using meropenem and moxifloxacin, and turned to maintenance treatment with dexamethasone and
ampicillin. We comprehensively managed his vital signs and physical organ functions, we also controlled some comorbidities. During the hospitalization period thereafter, we used intravenous anti-infection treatment with moxifloxacin 0.4 g, qd,
ampicillin 0.5 g, q4h.
RESULTS: Half a year later, the reexamination showed only protein elevation in cerebrospinal fluid and hydrocephalus in MRI. Afterward, the symptoms did not recur again. The patient recovered well after discharge.
CONCLUSIONS: LM meningoencephalitis complicated with lower limb muscle lesions is clinically rare. This report focuses on relevant treatment plans, which provide value for the examination and comprehensive management of patients with LM infection in the future.