# Case Report: A case of disseminated cutaneous listeriosis following appendicitis from Lao PDR

## TL;DR

A woman in Laos died from rare skin listeriosis after appendicitis, highlighting the disease's severity and challenges in low-resource settings.

## Contribution

This case report documents a rare instance of disseminated cutaneous listeriosis without known risk factors in a low-income country.

## Key findings

- The patient presented with disseminated cutaneous listeriosis following appendicitis.
- Treatment with meropenem and ampicillin failed to prevent mortality.
- The case underscores diagnostic and treatment challenges in low-resource settings.

## Abstract

Listeria monocytogenes is a food-borne pathogen that is a rare cause of bacteraemia and meningitis in immunosuppressed patients, and carries a high mortality rate. Cutaneous manifestations of listeriosis are rare, and are usually associated with direct inoculation of the skin.

A 41-year-old woman who initially presented to a hospital in Laos with appendicitis was diagnosed with disseminated cutaneous listeriosis without recognised risk factors. Intra-abdominal pathology probably contributed to bacterial bloodstream invasion. Initial treatment with meropenem was switched to ampicillin based on best practice, however our patient died 5 days after diagnosis.

This case highlights listeriosis as an important cause of mortality in low- and middle-income countries, exacerbated by poor availability of laboratory diagnostics and ineffective empiric antibiotic regimens. Improvements in food hygiene, surveillance, and increased laboratory capacity are important strategies to reduce rates of infection and clinical outcomes.