Listeria sepsis after endoscopic treatment of esophagus varix rupture

Introduction: Gastrointestinal endoscopy followed by Listeria septicaemia has been reported four times in known literature before. This is the first presented case, when this complication occured after a therapeutic esophagus procedure.

Case report: A diabetic, cirrhotic patient was admitted with hematemesis and melaena. Gastroscopy, sclerotherapy, endoscopic varix ligation was performed. Five days after admission he developed fever. The blood culture grew a gram-positive aerobic bacterium that was determined to be Listeria monocytogenes. Bacterial endocarditis was revealed by echocardoigraphy. Parenteral administration of Augmentin was started, later Gentamycin was added. 25 days from his admission a second varix ligation had to be done because of rebleeding. The antibiotic therapy was contuniued for 32 days, his fever disappeared, leucocyte count, CRP normalised, we discharged him symptome free.

Summary: According to the literature the bacteriaemia after sclerotherapy is between 4 and 53%, after ligation is between 0 and 25%. In patients having normal immune system, the bacteriaemia is only transient, and the clinical significance is very low. In case of an immunocompromised patient, serious complications may occur. Listeria infection can be due to esophagus tamponade, sclerotherapy, ligation. Blood cultures collected in fever after therapeutic endoscopic procedures can be useful discovering such rare complications.