A case report of oral sulfamethoxazole in the treatment of posttransplant Listeria monocytogenes meningitis

Background: Renal transplant recipients are prone to Listeria monocytogenes (Lm) infection due to immunosuppressive therapies. Ampicillin or penicillin G is regarded as the first-line treatment of Lm meningitis. For patients with allergy to penicillin, convention to trimethoprim-sulfamethoxazole (TMPSMX) iv should ideally be performed since TMP-SMX remarkable bactericidal activity. But there's still scarcity of reports indicating oral TMP-SMX regimen on Lm meningitis.Case Description: A 30-year-old male who received a renal transplant 4 months ago was admitted to the hospital with generalized pain and headache for 3 days accompanied by diarrhea and fever for 1 day. The patient had been treated with regular oral immunosuppressants post-transplantation. After admission, the patient poorly responded to cefoperazone sulbactam and progressed rapidly with increasing headache, persistent diarrhea, diplopia, and dyspnea and was subsequently transferred to the intensive care unit (ICU) for ventilatory support. Later, as Lm was detected successively in the patient's blood culture and cerebrospinal fluid culture, the patient was diagnosed with Lm infection. Due to the patient's allergy to penicillins, the TMP-SMX was selected for oral treatment, and the patient well tolerated to TMP-SMX oral regimen without significant adverse effects and recovered after 2 weeks. After discharge, follow-up has shown that the patient has generally remained in good condition with stable graft function to date.Conclusions: The case of our study demonstrated Lm infection post renal transplantation can be cured by oral TMP-SMX. Furthermore, the recent research and clinical progress of Lm microbiological characteristics, clinical manifestations, diagnosis, and treatment of listeriosis were summarized.