J Korean Soc Radiol.  2017 May;76(5):363-368. 10.3348/jksr.2017.76.5.363.

Hemorrhagic Listerial Encephalitis in a Patient with Systemic Lupus Erythematosus: A Case Report

• Lee HG
• Lee JY
• Lee YJ
• Kim YS
• Kim HY
• Sung W
• Park DW

• KMID: 2377041
• DOI: http://doi.org/10.3348/jksr.2017.76.5.363

Abstract

A 31-year-old female with systemic lupus erythematosus (SLE) presented with fever, headache, seizures and mental status changes. Brain MRI showed T2 hyperintense lesions in the cerebellum and frontal white matter and a lesion in the cerebellum exhibited hemorrhagic changes and peripheral ring enhancement. The MRI features of listerial encephalitis are difficult to differentiate from those of neuropsychiatric SLE and various other diseases. Here, we report a case of hemorrhagic listerial encephalitis in a patient with SLE.

MeSH Terms

Adult
Brain
Cerebellum
Encephalitis*
Female
Fever
Headache
Humans
Listeria monocytogenes
Lupus Erythematosus, Systemic*
Magnetic Resonance Imaging
Seizures
White Matter

Figure

• 

  Fig. 1 Listerial encephalitis in a 31-year-old woman with systemic lupus erythematosus. T2-weighted axial images (A, B) show mass-like hyperintense lesions in the cerebellum and right frontal subcortical white matter. Low signal intensity of the central portion on T2-weighted axial image is correlated with hemorrhage on susceptibility weighted image (C). Diffusion weighted image (D) and apparent diffusion coefficient (E) map show no definite restricted diffusion.

• 

  Fig. 2 Follow up MR imaging on hospital day 14 after treatment with ampicillin and ceftriaxone. T2-weighted axial images (A, B) show a significant decrease in the extent of mass-like hyperintense lesions in the cerebellum and right frontal subcortical white matter. T1-weighted (C) and susceptibility-weighted (D) axial images show hypersignal intensity of the hemorrhagic central core, consistent with late subacute hemorrhage. Diffusion weighted image (E) and apparent diffusion coefficient map (F) show restricted diffusion of the hemorrhagic core in the cerebellar lesion. A contrast-enhanced T1-weighted image (G) shows peripheral ring enhancement in the cerebellum.

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