Neurologische uitval na operatie van een aneurysma aortae

A 58-year-old man with a history of sarcoidosis and relapsing fever, for which he used corticosteroids, underwent a laparotomy and implantation of an aortic prosthesis because of a rapidly growing infrarenal aneurysm. Postoperatively, the patient had a fever, a state of slightly diminished consciousness, aphasia and a Babinski sign on the right. Brain CT revealed a hypodensity in the left hemisphere, interpreted as an ischaemic stroke. Shortly after the initiation of aspirin therapy, the patient developed a comatose state with a severe left hemiparesis, caused by a large haemorrhage in the right basal ganglia. Cultures of blood and cerebrospinal fluid were positive for Listeria monocytogenes and the patient died from the sequelae of these disorders. Autopsy revealed the existence of multiple Listeria brain abscesses; the aortic aneurysm had probably been infected as well. Symptomatic Listeria infection in adults is often associated with immunosuppression, but is also found in otherwise healthy persons. Complications include infection of the central nervous system and formation of abscesses and mycotic aneurysms. Treatment consists mainly of antibiotics and sometimes surgical drainage of an abscess.