A case of fulminant Listeria-rhombencephalitis with brainstem abscesses in a 37-year-old immunocompetent patient: from vestibular neuritis to Ondine’s curse

We present a rare case of Listeria monocytogenes (LM) rhombencephalitis with formation of multifocal abscesses in a young immunocompetent patient. His initial symptoms of dizziness, headache, and feeling generally unwell were put down to a coincidental co-infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The unfortunate rapid progression to trigeminal, hypoglossal, vagal, facial, and abducens nuclei palsies, and then an acquired central hypoventilation syndrome, known as Ondine’s curse, required a prolonged intensive care unit (ICU) stay, and prolonged mechanical ventilation. As they continued to deteriorate despite targeted antibiotic treatment, surgical drainage of the abscesses was seen as the only meaningful available treatment option left to contain the disease. Postoperatively, the patient’s strength rapidly improved as well as the severity of the cranial nerve palsies. After prolonged rehabilitation, at three months follow up the patient was weaned off mechanical ventilation, independently mobile, and was left with only minor residual neurological deficits. This case highlights a number of interesting findings only touched upon in current literature including, route of entry of LM into the central nervous system, the rare entity of acquired central hypoventilation syndrome, and lastly the use of surgical intervention in cerebral LM infections.