Case report| Volume 24, P38-41, August 2018

Mortality from Listeria monocytogenes meningoencephalitis following escalation to alemtuzumab therapy for relapsing-remitting Multiple Sclerosis


      • This was the first reported mortality due to listeria associated with alemtuzumab therapy in the setting of Multiple Sclerosis.
      • The rapid and fulminant presentation had symptoms which commonly occur following routine administration of alemtuzumab.
      • The Acute Phase post administration appears to confer particular vulnerability to this pathogen therefore high vigilance for this complication is mandatory.


      We report the case of a patient who died from the rare complication of Listeriosis in the immediate phase following alemtuzumab administration one month after discontinuing dimethyl fumarate (DMF). There is considerable overlap with typical post-infusion symptoms therefore high surveillance and low threshold for empirical or possible prophylactic antibiotic therapy is advocated.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Multiple Sclerosis and Related Disorders
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Group AoBNMA. Guidance on the prevention of Listeria infection after alemtuzumab treatment of multiple sclerosis. 2017.

        • Brouwer MC
        • van de Beek D
        • Heckenberg SG
        • Spanjaard L
        • de Gans J
        Community-acquired Listeria monocytogenes meningitis in adults.
        Clin. Infect. Dis. 2006; 43: 1233-1238
        • Coles AJ
        • Compston DA
        • Selmaj KW
        • Lake SL
        • Moran S
        • Margolin DH
        • et al.
        Alemtuzumab vs. interferon beta-1a in early multiple sclerosis.
        N. Engl. J. Med. 2008; 359: 1786-1801
        • Decard BF
        • Thone J
        • Haghikia A
        • Bornke C
        • Anders A
        • Lukas C
        • et al.
        Listeria rhombencephalitis mimicking a demyelinating event in an immunocompetent young patient.
        Multiple Sclerosis. 23. Houndmills, Basingstoke, England2017: 123-125
        • Disson O
        • Lecuit M
        Targeting of the central nervous system by Listeria monocytogenes.
        Virulence. 2012; 3: 213-221
        • Holmoy T
        • von der Lippe H
        • Leegaard TM
        Listeria monocytogenes infection associated with alemtuzumab—a case for better preventive strategies.
        BMC Neurol. 2017; 17: 65
        • National Clinical Guideline Centre
        National Institute for Health and Care Excellence: Clinical Guidelines.
        Multiple Sclerosis: Management of Multiple Sclerosis in Primary and Secondary Care. National Institute for Health and Care Excellence, London2014 (UK). Copyright (c) National Clinical Guideline Centre, 2014
        • Ohm S BA
        • Mackert BM
        • et al.
        Alemtuzumab related Listeria infections—a growing concern?.
        in: 31st Congress of the European Commitee for Treatment and Research in Multiple Sclerosis (ECTRIMS). Barcelona, Spain2015 October 7-10 2015
        • Ohm S BA
        • Mackert BM
        • et al.
        Alemtuzumab related Listeria infections—a growing concern?.
        Mult. Scler. J. 2015; 23: 582-583
        • Osterborg A
        • Karlsson C
        • Lundin J
        • Kimby E
        • Mellstedt H
        Strategies in the management of alemtuzumab-related side effects.
        Semin. Oncol. 2006; 33: S29-S35
        • Prats N
        • Lopez S
        • Domingo M
        • Briones V
        • Garcia JA
        • Dominguez L
        • et al.
        Prolonged persistence of Listeria monocytogenes after intragastric infection in corticosteroid-treated mice.
        Vet. Microbiol. 1997; 58: 79-85
        • Rau D
        • Lang M
        • Harth A
        • Naumann M
        • Weber F
        • Tumani H
        • et al.
        Listeria meningitis complicating alemtuzumab treatment in multiple sclerosis–report of two cases.
        Int. J. Mol. Sci. 2015; 16: 14669-14676
        • Thomas K
        • Eisele J
        • Rodriguez-Leal FA
        • Hainke U
        • Ziemssen T
        Acute effects of alemtuzumab infusion in patients with active relapsing-remitting MS.
        Neurol. (R) Neuroimmunol. Neuroinflammation. 2016; 3: e228