Unusual Presentation of <i>Listeria</i> Rhombencephalitis

We present the case of a middle-aged woman with reports of left cheek numbness, myalgias, and low-grade fever, which initially led to the suspicion of herpes simplex infection. Magnetic resonance imaging of the brain and spine revealed peripherally enhancing left pontine and cervical spinal cord lesions suspicious for brainstem and spinal cord abscesses with left trigeminal nerve enhancement. Blood cultures were positive for Listeria monocytogenes 2 days into hospital course. The postulated route of infection is the direct inoculation of L monocytogenes into a preexisting damaged oropharyngeal mucosa, leading to trigeminal nerve infection, followed by perineural spread along the trigeminal nerve branches, and resulting in brainstem abscess formation.