A218 LISTERIA MONOCYTOGENES MENINGITIS IN A NEWLY DIAGNOSED PATIENT WITH INFLAMMATORY BOWEL DISEASE: A CASE REPORT
Bibliographic record
Abstract
Abstract Background Anti-Tumor Necrosis Factor (TNF) is a frequently utilized therapy in the treatment of Inflammatory Bowel Disease (IBD). Opportunistic infections are a known but an infrequently encountered complication. Listeria monocytogenes (LM) is an aerobic gram-positive intracellular bacillus. Clinical presentation of infection is host dependent, ranging from self-limited illnesses in immunocompetent individuals to life-threatening sepsis and meningitis in the immunocompromised. TNF plays a crucial role in host’s defense against LM. Although published in adults, few case reports have documented invasive LM in children receiving infliximab (IFX), an anti-TNF agent used in IBD therapy. Aims Describe an adolescent with IBD-unclassified (IBD-U) in whom LM sepsis and meningitis was diagnosed after induction therapy with intravenous (IV) IFX. Methods Case report and literature review. Results A 15-year-old girl presented with 2-week history of progressive abdominal pain, bloody diarrhea, urgency, nocturnal stooling, tenesmus, and weight loss. She had been afebrile, with no history of exposures. Examination revealed pallor and tenderness in the right and left lower quadrants. Investigations showed elevated white cell count (WBC), platelets, inflammatory markers, and low albumin. Abdominal ultrasound showed thickening of the descending and sigmoid colon. Stool multiplex PCR was negative. Colonoscopy showed Mayo 3 pancolitis. The terminal ileum was not intubated and endoscopy was normal. She was diagnosed with IBD-U. Due to poor response to high dose IV steroids, IV IFX (after documenting normal vaccination titers) was given with good clinical response and no adverse effects; she was discharged on tapering prednisone. She re-presented 3 days later with fever, severe headaches, photophobia, and neck stiffness. Her IBD remained quiescent. She had consumed a cold meat sandwich 10 days prior. Antibiotics were started as investigations showed leukocytosis and very high inflammatory markers. Brain MRI showed pus in the lateral ventricles. Cerebrospinal fluid (CSF) analysis showed WBC 1832 x106/L, low glucose, and high protein. Blood and CSF cultures detected LM. She defervesced within 24 hours and completed a 21-day course of Ampicillin monotherapy. 2-month follow up showed IBD in continuous remission on IFX with no neurological sequalae, and a normal brain MRI. Conclusions This is the youngest patient with IBD reported with invasive listeriosis secondary to IFX and adds to 3 cases in children. It highlights the importance of vigilance when evaluating IBD patients with fever during IFX-based therapy. Physicians should be reminded of such patients’ immunocompromised state and their high risk of acquiring opportunistic infections. It is unclear if listeriosis avoidance precautions, currently recommended in pregnant women, should be adopted in patients receiving anti-TNF therapy. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.006 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".