This is a 35-year-old woman, with a family history of Crohn's disease and no pathological history of interest or toxic habits, who started with abdominal pain in FID plus weight loss. She was studied on an outpatient basis and was diagnosed with Crohn's disease with ileal and ileocaecal valve involvement (A1L1B2, Vienna 1998), according to clinical, endoscopic and histological criteria.
Treatment with mesalazine and steroids was started with good response. Due to corticodependence, treatment with azathioprine was started, and the patient remained steroid-free and in complete clinical remission, but symptomatology returned two years later. Infliximab was indicated and two doses were administered. Antinuclear antibodies, chest X-ray and viral serology were negative.
Two weeks later, the patient was admitted with a fever of 39°C, pain and difficulty in moving the neck. The previous week he had presented with general malaise and fever, and had been treated for three days with azithromycin on an outpatient basis. Physical examination revealed thinness (BMI 17), temperature 37 ºC, blood pressure 105/60, she was conscious and oriented, with complete normal neurological examination, oral thrush and normal cardiorespiratory and abdominal examination. Tests showed normocytic anaemia (9.9 g/dl Hb), leukocytes 6,700 with 84% segmented, platelets 363,000. Blood biochemical parameters were normal except for GOT 87, GPT 51, gamma-GT 67 and total proteins were 5.8 g/dl with albumin 1,400 mg/dl. Urinalysis and sediment were normal, as were chest and abdominal X-rays on admission. A lumbar puncture was performed, detecting normal glycorrhachia, proteinorrachia of 102 mg/dl, 960 cells/mm3 , 90% of which corresponded to polynuclear cells, Gram stain in which no germs were observed and positive culture for Listeria monocytogenes, leading to the diagnosis of Listeria meningitis, initiating antibiotic treatment and suspending all immunosuppressive medication.
Five days after hospitalisation, the patient presented with acute abdominal symptoms, with intestinal peritonitis secondary to perforation of the preterminal ileum and ileal stenosis, with the rest of the small intestine and colon remaining normal. Ileocecal resection and terminal ileostomy with mucosal fistula of the ascending colon were performed. Pathological anatomical pathology confirmed granulomatous inflammation compatible with Crohn's disease.
The evolution was favourable, completing antibiotic therapy with ampicillin and gentamicin for three weeks, with negative CSF at discharge. Azathioprine was reinstituted once stable and the infectious condition was overcome, and she was discharged 21 days after admission.