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Peer-reviewedCC BYCureus

Listeria monocytogenes Sepsis With Meningitis Complicating Biologic Immunosuppression in a Patient With Haemophagocytic Lymphohistiocytosis Secondary to Adult-Onset Still’s Disease: A Case Report

  • Haider Khan1
  • Muhammad Navid Bin Mohamad Sithik2
  • Amrita Gurung3
  • Eranda L Ranasinghe Arachchi4
  • Gary Meenagh5
5 affiliations
  1. 1General Internal Medicine, Southern Health and Social Care Trust, Craigavon, GBR
  2. 2Geriatrics, Southern Health and Social Care Trust, Craigavon, GBR
  3. 3Gastroenterology, Northern Health and Social Care Trust, Causeway, GBR
  4. 4Medicine, Health Education England, Cambridge, GBR
  5. 5Rheumatology, Northern Health and Social Care Trust, Antrim, GBR
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Abstract

Adult-onset Still’s disease (AOSD) and haemophagocytic lymphohistiocytosis (HLH) are treated with potent immunosuppression, including high-dose corticosteroids and biologic agents such as anakinra, which can result in an increased risk of opportunistic infections such as listeriosis (infection with Listeria monocytogenes (L. monocytogenes)). This case report describes a 34-year-old man on a background of AOSD receiving escalated doses of steroids and anakinra for a probable flare-up of HLH. Whilst inpatient, he developed high-grade pyrexia (39.3°C), acute confusion, and neurological deterioration, requiring admission to the ICU for intubation and ventilatory support. Investigations revealed blood cultures positive for L. monocytogenes, and lumbar puncture findings were consistent with acute bacterial meningitis. The patient clinically improved with targeted antimicrobial therapy and was successfully extubated, with subsequent normalisation of his inflammatory markers. He was discharged with a planned taper of his immunosuppressive therapy. This case emphasises the synergistic risk of infection associated with biologic therapy and high-dose corticosteroid use and the importance of maintaining a low threshold for considering listeriosis in immunocompromised patients, particularly in the presence of neurological deterioration.

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Cite

BibTeXRIS
BibTeX
@article{khan2026listeria,
  title = {{Listeria monocytogenes Sepsis With Meningitis Complicating Biologic Immunosuppression in a Patient With Haemophagocytic Lymphohistiocytosis Secondary to Adult-Onset Still’s Disease: A Case Report}},
  author = {Haider Khan and Muhammad Navid Bin Mohamad Sithik and Amrita Gurung and Eranda L Ranasinghe Arachchi and Gary Meenagh},
  journal = {Cureus},
  year = {2026},
  month = oct,
  doi = {10.7759/cureus.117297},
  url = {https://europepmc.org/article/PMC/PMC13723186},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Listeria monocytogenes Sepsis With Meningitis Complicating Biologic Immunosuppression in a Patient With Haemophagocytic Lymphohistiocytosis Secondary to Adult-Onset Still’s Disease: A Case Report
AU  - Haider Khan
AU  - Muhammad Navid Bin Mohamad Sithik
AU  - Amrita Gurung
AU  - Eranda L Ranasinghe Arachchi
AU  - Gary Meenagh
PY  - 2026
DA  - 2026/10/01
JO  - Cureus
DO  - 10.7759/cureus.117297
UR  - https://europepmc.org/article/PMC/PMC13723186
AB  - Adult-onset Still’s disease (AOSD) and haemophagocytic lymphohistiocytosis (HLH) are treated with potent immunosuppression, including high-dose corticosteroids and biologic agents such as anakinra, which can result in an increased risk of opportunistic infections such as listeriosis (infection with Listeria monocytogenes (L. monocytogenes)). This case report describes a 34-year-old man on a background of AOSD receiving escalated doses of steroids and anakinra for a probable flare-up of HLH. Whilst inpatient, he developed high-grade pyrexia (39.3°C), acute confusion, and neurological deterioration, requiring admission to the ICU for intubation and ventilatory support. Investigations revealed blood cultures positive for L. monocytogenes, and lumbar puncture findings were consistent with acute bacterial meningitis. The patient clinically improved with targeted antimicrobial therapy and was successfully extubated, with subsequent normalisation of his inflammatory markers. He was discharged with a planned taper of his immunosuppressive therapy. This case emphasises the synergistic risk of infection associated with biologic therapy and high-dose corticosteroid use and the importance of maintaining a low threshold for considering listeriosis in immunocompromised patients, particularly in the presence of neurological deterioration.
SN  - 2168-8184
ER  -