Listeria rhomboencephalitis in a patient on a tumor necrosis factor α inhibitor (etanercept)

Benji K. Mathews, Charles Chuang, Ajay Rawal, Elie Gertner

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


We describe a case of an 87-year-old woman with rheumatoid arthritis on etanercept who developed subacute encephalopathy. Magnetic resonance imaging and blood cultures led to the diagnosis of Listeria monocytogenes rhomboencephalitis, which proved to be fatal. Postmortem examination of the brain revealed abscesses with extensive necrosis. Gram stain showed small gram-positive rods in the necrotic tissue and the wall lining the abscesses. While rhomboencephalitis is a rare entity, and clinical recognition may be hampered by immunosuppression such as in this case, early blood cultures, lumbar puncture, and empiric treatment with ampicillin should be initiated in all patients with suspected rhomboencephalitis if suggested by imaging and by a clinical concern for infection.

Original languageEnglish (US)
Pages (from-to)325-327
Number of pages3
JournalJournal of Clinical Rheumatology
Issue number6
StatePublished - Sep 2014


  • Listeria monocytogenes
  • encephalopathy
  • rheumatoid arthritis
  • rhomboencephalitis

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