We discussed a case about an elderly woman with insulin-dependent T2DM and rheumatoid arthritis (on methotrexate and hydroxychloroquine), who presented with subacute-chronic post-prandial abdominal pain, loose stools, mental status changes, found to have chronic SMA stenosis & Listeria bacteremia.

Individuals at highest risk of Listeria

• Immunocompromised
• Extremes of age (neonates & elderly)
• Pregnant women

Clinical syndromes of Listeria

• Febrile gastroenteritis
• Invasive infections
  • Bacteremia
  • CNS infection (meningitis, encephalitis)
• Focal infections (rarer, mostly case reports; e.g. septic arthritis, endocarditis, SSTI)

Treatment

• Antibiotics of choice: Ampicillin or Penicillin G
• Synergistic effect: Gentamicin
  • Watch out for nephrotoxicity and ototoxicity with Gentamicin