Neurolisteriosis with a stroke-like presentation in a male adult with polymyalgia rheumatica: a case report and literature review

Listeria monocytogenes is a gram-positive bacillus that can cause a wide spectrum of clinical manifestations, ranging from paucisymptomatic to life-threatening disease. Central nervous system involvement is called neurolisteriosis and is a rare and severe entity that includes meningitis, meningoencephalitis, rhombencefalitis, and brain abscess, and it may start with a stroke-like presentation. People with rheumatic diseases taking immunosuppressive medications are at increased risk, and they also can have atypical presentations, misleading the diagnosis of infection. Magnetic resonance imaging can guide the diagnosis; however, a high clinical suspicion and a microbiological confirmation are needed. Here we present a case of Listeria monocytogenes brain abscess mimicking an ischemic stroke that occurred in a male patient with a previous diagnosis of polymyalgia rheumatica under immunosuppressive treatment. A literature revision was also performed.