Listeria spinal cord abscess responsive to trimethoprim-sulfamethoxazole monotherapy

Objective: To describe an alternative antibiotic regimen for the treatment of central nervous system Listeria monocytogenes infection. Background: Cla ssical treatment of listeria infections of the brain and spinal cord has in cluded ampicillin in combination with gentamicin and chloramphenicol. Antib iotic resistance to L. monocytogenes is extraordinarily low, and the combin ed risks of nephrotoxicity, ototoxicity, and agranulocytosis in an already critically ill patient make the potential use of trimethoprim-sulfamethoxaz ole monotherapy for coverage or treatment of listeria an important alternat ive. Methods: Case report. Results: A 58-year-old woman presented with a tw o-week history of progressive quadriplegia. Gadolinium enhanced MRI showed diffuse edema of the cervical and thoracic spine with ring-enhancing lesion s, Cerebrospinal fluid and blood cultures both grew L. monocytogenes. Spina l cord biopsy of the lesion revealed inflammation with necrosis and also gr ew listeria. Intravenous trimethoprim-sulfamethoxazole (8 mg/kg in four div ided doses) was administered for six weeks with resultant arrest of neurolo gical symptoms and stabilization of the clinical course. Although the patie nt was quadraparetic she was able to be discharged to a rehabilitation faci lity. Conclusions: Trimethoprim-sulfamethoxazole monotherapy may be a poten tial alternative option for critically ill patients with central nervous sy stem L. monocytogenes infection.