Case Report Pneumonia by Listeria monocytogenes: A Common Infection by an Uncommon Pathogen Theocharis Koufakis, 1 Marianneta Chatzopoulou, 2 Anastasios Margaritis, 1 Maria Tsiakalou, 2 and Ioannis Gabranis 1 1 Department of Internal Medicine, General Hospital of Larissa, 1 Tsakalof Street, 41221 Larissa, Greece 2 Department of Microbiology, General Hospital of Larissa, 41221 Larissa, Greece Correspondence should be addressed to heocharis Koufakis; thkoyfak@hotmail.com Received 17 November 2014; Revised 15 December 2014; Accepted 16 December 2014 Academic Editor: Larry M. Bush Copyright © 2015 heocharis Koufakis et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Infections by Listeria monocytogenes typically occur in infants, the elderly, pregnant women, and immunosuppressed subjects. Pulmonary infections in adults are extremely uncommon and only few reports can be found in the literature. We here report a case of Listeria pneumonia in an 85-year-old female patient and we discuss our diagnostic and therapeutic approach. Despite being rare and in most cases diicult to be identiied, Listeria pneumonia should always be considered in immunosuppressed patients, presenting with fever and symptoms from the lower respiratory system. 1. Introduction Listeria monocytogenes (named ater the English pioneer of antiseptic surgery Joseph Lister), is a gram-positive, motile, rod-shaped bacterium. Most infections in humans are con- sidered to be foodborne, partly due to the microorganism’s property to proliferate at cooling temperatures, with cheese and unpasteurized milk being the most common sources [1]. he major form of person to person transmission is from mother to child transplacentally or at birth. It is generally considered as a rare pathogen, given that the reported incidence of Listeria infections in Europe is estimated to be between 0.3 (in Greece) and 7.5 (in Sweden) cases per year [2]. Listeriosis occurs primarily as bacteremia and/or meningitis, while pulmonary infections in adults are extremely uncom- mon [3] and only few reports can be found in the literature. 2. Case Presentation An 85-year-old female patient presented to the emergency department with fever, cough, and dyspnea. Her symptoms began three days prior to presentation. She had a history of splenectomy ater a car crash as well as of rheumatoid arthritis. She was on methotrexate (10 mg once a week) and prednisolone (12.5 mg once a day). he patient’s main clinical and laboratory indings on admission were as follows: fever (38 ∘ C), sinus tachycardia (120 beats per minute), tachypnea (30 breaths per minute), difuse crackles heard on lung aus- cultation, hypoxygonemia (PO 2 56 mm Hg), pancytopenia (hemoglobin 9.0 g/dL, white cell count 3.0 × 10 9 /L, platelet count 120 × 10 9 /L), elevated inlammation markers (C- reactive protein 17 mg/dL, and erythrocyte sedimentation rate 90 mm/h), and abnormal glomerular iltration rate (70 mL/min/1.73 m 2 ). Her chest X-ray demonstrated difuse bilateral opacities, mainly at the right side. Further evaluation with high resolution chest computed tomography revealed distortion of the pulmonary architecture with thickening of pulmonary interstitium and areas of ground-glass mor- phology, as well as right lower lobe opacities (Figure 1). he overall imaging indings gave us the impression of a severe infection occurring upon a chronic respiratory disease (probably pulmonary ibrosis). Urine, blood, and sputum samples were collected and sent for culture and empiric therapy with moxiloxacin was started, as well as supportive care with luids and oxygen. Methotrexate was withdrawn but not prednisolone, due to the possibility of Hindawi Publishing Corporation Case Reports in Infectious Diseases Volume 2015, Article ID 627073, 3 pages http://dx.doi.org/10.1155/2015/627073