Abstract 4145267: An Unusual Case of Listeria LVAD Infection Complicated by Intracranial Catastrophe

Description of Case: A 56-year-old male with ischemic cardiomyopathy, HeartMate 3 LVAD implantation presented with fatigue and diarrhea after eating expired cheese a week prior. Hypovolemia, AKI, an unremarkable LVAD interrogation and an INR of 3.4 were noted. Blood cultures and infectious work-up including imaging were obtained. Imaging was unremarkable. Over the first 2 hospital days, he was fluid resuscitated. Hemodynamics showed low biventricular filling pressures and adequate cardiac index. On hospital day 3, blood cultures revealed Listeria monocytogenes prompting initiation of IV ampicillin. AKI worsened, associated with altered mentation requiring endotracheal intubation and renal replacement therapy. On hospital day 8, bronchoscopy was performed to address worsening respiratory secretions. An hour after procedural sedation, he never regained consciousness and anisocoria was noted. Emergent cranial imaging revealed multicompartment hemorrhage with midline shift. Neurosurgical intervention was not recommended due to the catastrophic nature of the bleeding. Supportive pharmacologic measures were futile; brain death was declared 48 hours later. Discussion: Listeria monocytogenes is a gram-positive rod which causes gastrointestinal illness in immunocompetent adults. Cases of Listeria bacteremia in patients with indwelling cardiac hardware are rare but have been previously described in the literature. A case of Listeria bacteremia and leukocytoclastic vasculitis in an LVAD patient resulting in AKI has been reported. To our knowledge, this is the first published case of Listeria bacteremia in an LVAD patient complicated by acute intracranial hemorrhage. While the exact mechanism of the brain bleed was not confirmed, it is postulated that the altered mental status and AKI were the products of septic embolization to the brain and kidneys, with ultimate hemorrhagic conversion noted in the setting of therapeutic anticoagulation. A transesophageal echocardiogram had been planned prior to the stroke but not performed due to medical futility. Clinicians should be aware of the more unusual complications of Listeria infection in the setting of indwelling cardiac hardware.