MEDITERRANEAN JOURNAL OF RHEUMATOLOGY 30 4 2019 196 CASE REPORT This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. INTRODUCTION Listeria monocytogenes is a gram-positive facultative intracellular bacterium responsible for severe infec- tions mainly in immunocompromised and diabetic patients, individuals at the extremes of age namely neonates and older adults, pregnant women and occasionally, healthy individuals with no comorbidities. 1,2 Transmission of Listeria is via the faecal-oral route through the ingestion of contaminated food such as milk, vegetables and meat. We describe a case of CNS infection with L. Monocytogenes presenting as inter- mittent fever for over a month, recurrent episodes of headaches, disorientation and other neurological symptoms, which were misdiagnosed as possible Giant Cell Arteritis (GCA) and the patient was ABSTRACT Background: Listeria monocytogenes is an opportunistic pathogen that causes severe infections of the Central Nervous System, such as meningitis or meningoencephalitis, and brain abscesses. Abscesses account for approximately 1-10% of CNS listerial infections and are observed in 1% of all listerial infections. Methods: We describe a case of 70-year-old male patient who had several admissions in diferent hospitals over the last 8 weeks. Results: He sufered from intermittent fever for over a month, recurrent episodes of headaches, disorientation and other neurological symptoms. His condition was misdiagnosed as giant cell arteritis and initially the patient was started on corticosteroids. MRI of the brain revealed the presence of multiple brain abscesses and the cerebrospinal fuid study confrmed the presence of Listeria Monocytogenes. The patient was started on ampicillin and he completed a 6 weeks’ course of treatment. Conclusions: This case emphasizes the need to include rare pathogens in the diferential diagnosis when possible CNS infections are involved, as well as to show that in many cases some auto-immune diseases are overdiagnosed. Mediterr J Rheumatol 2019;30(3): ................. doi.................... Article Submitted: 21 Jul 2019; Revised Form: 10 Oct 2019; Article Accepted: 14 Oct 2019 Cite this article as: Vettas C, Dimosiari A, Kydona C, Pyrpasopoulou A, Avdelidou E, Roilidis E, Garyfallos A, Dimitroulas T. Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis. Mediterr J Rheumatol 2019;30(4):In press. ©Vettas C, Dimosiari A, Kydona C, Pyrpasopoulou A, Avdelidou E, Roilidis E, Garyfallos A, Dimitroulas T. Keywords: listerial infection of CNS, listeriosis, brain abscess, cerebritis. Corresponding author: Christos Vettas Fourth Department of Internal Medicine Hippokration University Hospital Medical School, Aristotle University of Thessaloniki 541 24 Thessaloniki, Greece Tel.: +30 231 099 9900 E-mail: chrisvettas@gmail.com Fever and temporal headache in a 70-year-old male with presumed large vessels vasculitis Christos Vettas 1 , Athina Dimosiari 1 , Christina Kydona 1 , Athina Pyrpasopoulou 2,4 , Eugenia Avdelidou 5 , Emmanouil Roilidis 3,4 , Alexandros Garyfallos 1 , Theodoros Dimitroulas 1 1 Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, 2 Second Propedeutic Clinic of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, 3 Third Department of Paediatrics, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, 4 Department of Infectious Diseases, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece, 5 Department of Neurology, Hippokration University Hospital, Thessaloniki, Greece