Bilateral Facial Nerve Palsy Following Antibiotic Treatment for Listeria Monocytogenes Meningitis

Listeria monocytogenes (LM) is an intracellular, facultative, gram-positive bacillus transmitted mainly through contaminated food, particularly dairy products and cold deli meats. It typically affects immunocompromised patients, and a rarely neuroinvasive disease in immunocompetent healthy adults has been described in the literature. Despite the timely intervention, neurologic morbidity has been observed after extended periods of recommended antibiotic regimens. This case study highlights the challenges in diagnosing and managing LM meningitis, especially when atypical symptoms and complications arise. Herein, we describe the case of a 57-year-old healthy man admitted with symptoms of nausea, vomiting, headache, neck pain, and stiffness, who was eventually diagnosed with LM-related meningitis and treated with antibiotics. The patient’s hospital course was complicated by bilateral facial nerve palsy, while other symptoms improved with antibiotic treatment, raising suspicion for parainfectious immunological response, which improved with a short course of steroids. This case contributes to the medical literature by providing insights into the immunological response for treating LM meningitis and managing LM meningitis–associated complications. To our knowledge, this could potentially be the first case of LM meningitis causing the parainfectious immunological response of bilateral facial nerve palsy after antibiotic treatment.