A 61-year-old female patient with a history of type 2 diabetes mellitus, arterial hypertension and Child B liver cirrhosis of unknown etiology, under control in a polyclinic gastroenterology clinic.
She presented with a one-week history of fever, predominantly at night, which was quantified up to 39°C and preceded by a day of self-limiting non-disordered diarrhoea.
The patient was evaluated in the emergency department. Tests were performed, including: blood count without leukocytosis or left shift, coagulation tests, normal plasma electrolytes and renal function.
Abdominal ultrasound showed chronic enlarged spleen, signs of liver damage and diverticular disease of the colon.
Fever was not recorded and the patient was discharged without specific drug therapy.
Given the persistence of fever for more than a week since the first consultation, she was hospitalized for study.
The patient developed respiratory and digestive symptoms, but had no other episodes of diarrhea.
Physical examination revealed fever up to 38.7°C, cutaneous blood pressure 140, heart rate 108 per min, skin and hydrating mucous membranes, without palpable lymphadenopathy, telangiectasia, i lesions were not observed.
Cardiopulmonary arrest was normal; the abdomen was glossy, blade, depressible and painless, with no ascites or collateral circulation.
Rest of the normal test.
The study carried out during the hospitalization included: hemocultivated patients (Bact Alert), urocultiva, immunological and imaging tests.
Immunological laboratory tests revealed negative antinuclear antibodies (ELISA bin-ding-sité): complement C3: 86.3 mg/dL (VR: 90-180 mg negative plaque), C4VR: 17.3 mg/dL
A chest X-ray revealed a normal-sized cardiac silhouette, symmetrical lung fields, with no foci of condensation.
Elevated hypotension and persistent fever with mild to moderate holocrane headache oppressive-pulsatile type and mild retro-ospressive hypersensitivity pain associated with bradycardic pain
The electrocardiogram showed sinus bradycardia, normal ST segment, cardiac enzymes were normal.
Transcutaneous echocardiography revealed mild septal hypertrophy and presence of mild to moderate pericardial effusion; chest X-ray showed increased size of the cardiac silhouette and pleural effusion.
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The hemocultives (2) were positive at 20 and 21 hours of incubation; Gram stain revealed short gram (+) bacilli, non-sporulated.
She was transferred to culture media: cord blood agar (Biome-rieux ), chocolate agar (Biomerieux ) and brain-heart broth, growing small colonies, non-collaid blood bacillus, gray
The development was at 4°C, with mobility at 20°C in tumbos and at 25°C in paraguas, of the classical biochemical tests: sculpture (+), hypure (+), hydrolysis.
Biochemical identification by Vitek system (Biomerieux) was Listeria spp., which was confirmed by Instituto de Salud Pública as L.
Antimicrobial susceptibility testing performed on equipment was sensitive to ampicillin, gentamicin and trimethoprim-sulfamethoxazole.
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Lumbar puncture was performed, obtaining cerebrospinal fluid without difficulty, which was colourless, of clear appearance, without leukocytes, glucose 76 mg/dL, total proteins 0.05 g/L, ADA 5 U/L, and aerobic current culture negative.
Antimicrobial treatment was initiated immediately after lumbar puncture and knowing the result of Gram stain of hemocultives, with ampicillin 1 g every 6 h plus amikacin 600 mg/day was negative.
She was treated with febriculae during the first 72 h of treatment, so the dose of ampicillin was increased to 2 g every 6 h and amikacin was suspended when CNS involvement was ruled out.
Subsequently, affiliates continued and inflammatory parameters decreased.
Other tests performed: anti-HIV antibodies (ELISA), surface antigen hepatitis B and anti-HCV antibodies that were negative: alpha-fetoprotein 3.62 IU/mL (VR: 0-5.81), serum protein electrophoresis was performed.
A control chest X-ray showed a slight increase in pleural effusion. Aerobic staining was performed, with a diagnostic current of 0.67, glucose tolerance test 18dL, leukocyte count 600 cells/mm3, 61% mononuclear and 39% polymorphous nuclear pH, 3 g.
A computerized axial tomography of the abdomen and pelvis was performed to rule out intra-abdominal foci, which showed signs of chronic liver damage with enlarged pelvis, moderate amount of fluid without stenosis.
Transthoracic echocardiography showed decreased pericardial effusion.
After completing 14 days of intravenous treatment, it was decided to discharge the patient, continuing with ampicillin therapy for 7 days.
The subsequent evolution was favorable from the clinical and laboratory point of view with negative control blood cultures.
