Case-Based Modules > Case 33 > Conclusion

Great job! This case highlights the importance of having a high index of suspicion for acute infectious meningoencephalitis. We had to identify the correct antibiotics to empirically cover for this, and that decision was informed by having an understanding of the typical causative organisms. We let the clinical exam guide us in deciding to pursue an MRI brain, and it turns out that the radiographic finding provided a hint as to the ultimate causative etiology.

Pearl 1: Don't forget to include Listeria coverage as part of your empiric community-acquired meningoencephalitis regimen for patients aged ≥ 50.

Listeria is covered by ampicillin, which you'd dose at 2g q4h. Listeria is also of concern for patients less than 1 month old.


Pearl 2: The most common causes of an infectious rhomboencephalitis include Listeria and enterovirus.

There are many other uncommon and rare causes. HSV uncommonly can do this. In terms of autoimmune causes, neuro-Behcet's is actually a common etiology.

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