Medicine (Baltimore). 2025 Dec 19;104(51):e46352. doi: 10.1097/MD.0000000000046352.
ABSTRACT
RATIONALE: Pregnancy complicated by acquired immunodeficiency syndrome can result in a dual state of immune suppression, significantly increasing susceptibility to intracellular pathogens. Listeria monocytogenes (L. monocytogenes), a placenta-tropic lethal pathogen, is extremely rare in pregnant women infected with the human immunodeficiency virus (HIV). However, when it does occur, it often leads to maternal sepsis, premature birth, or fetal death.
PATIENT CONCERNS: The patient was a 36+²-week pregnant woman who presented with a 4-day history of persistent fever and was known to be HIV-positive. Laboratory tests indicated an elevated neutrophil percentage and an increased C-reactive protein level. Imaging studies revealed bilateral renal hydronephrosis. Blood culture confirmed a L. monocytogenes infection, identified with 99% confidence by Vitek2.
DIAGNOSIS: When pregnant women who are HIV-positive experience unexplained fever, there should be a heightened alert for potential opportunistic infections, such as Listeria. It is recommended that blood cultures and molecular testing be conducted within 24 hours.
INTERVENTIONS: Due to the patient's allergy to β-lactam antibiotics, a breakthrough treatment regimen consisting of linezolid combined with imipenem and cilastatin was selected.
OUTCOMES: After 3 days of treatment, the patient's temperature returned to normal, and both the mother and the infant were discharged in good health.
LESSONS: HIV infection during pregnancy, when complicated by L. monocytogenes bacteremia, is extremely rare; however, it carries a very high mortality rate. This case study represents one of the few documented instances of HIV infection complicated by L. monocytogenes bacteremia during pregnancy. It underscores the necessity for clinicians to enhance early detection and implement precise interventions for these rare co-infections to optimize maternal and infant outcomes.
PMID:41431092 | PMC:PMC12727361 | DOI:10.1097/MD.0000000000046352