Acute symptomatic hydrocephalus in Listeria monocytogenes meningitis

Listeria monocytogenes meningitis appears to have increased in incidence. Although most reported cases of listeriosis involve the central nervous system, brain computed tomography is usually normal. Hydrocephalus is a common complication of tuberculous meningitis, which has a high prevalence in Taiwan. However, patients with L. monocytogenes meningitis rarely develop the complication of symptomatic hydrocephalus. We report a patient with L monocytogenes meningitis who presented with persistent alteration of consciousness after appropriate antimicrobial therapy. Follow-up brain computed tomography revealed acute hydrocephalus. An Ommaya reservoir was implanted, and daily drainage of the cerebrospinal fluid was performed. The patient improved gradually and his mental status recovered completely 4 days later. This case should remind physicians to be aware of the possible occurrence of hydrocephalus in L monocytogenes meningitis and that prompt cerebrospinal fluid drainage may achieve a good outcome.