A Twist in the Tale - The Unmasking of Listeria in a PMR Case - Key Clinical Message

Sep 28, 2026

An older patient with proximal muscle pain and fatigue showed elevated inflammatory markers, initially suggesting polymyalgia rheumatica (PMR). After partial response to steroids, persistent symptoms and abnormal labs prompted emergency evaluation. In the intensive care unit, the patient was diagnosed with Listeria monocytogenes sepsis with central nervous system involvement and treated with antibiotics, leading to clinical improvement and discharge. The case emphasizes excluding unusual infections before attributing systemic inflammation to autoimmune rheumatic disease.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

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Abstract

Introduction

Case History/Examination

Differential Diagnosis, Investigations, and Treatment

Conclusion and Results (Outcome and Follow-Up)

Key Clinical Message

Clinical Case Reports CASE REPORT OPEN ACCESS A Twist in the Tale: The Unmasking of Listeria ina PMR Case Ghassan Al-Qaysi1 | Viswaja Kaja2 | Rishitha Anumola3 | Adegbenga Bankole1 1Division of Rheumatology, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA | 2Department of Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA | 3Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA Correspondence: Adegbenga Bankole ([aabankole@vt.edu](aabankole@vt.edu)) Received: 15 July 2025 | Revised: 15 November 2025 | Accepted: 21 December 2025 Keywords: autoimmune | infection | Listeria monocytogenes | polymyalgia rheumatica | rheumatology | sepsis ABSTRACT In general, an older patient presenting with proximal muscle pain and fatigue, with elevated inflammatory markers, would generally result in an extensive evaluation. If this is negative, it would be reasonable for a diagnosis of polymyalgia rheumatica (PMR) to be made and the patient referred to rheumatology. Our patient presented myalgia in proximal muscles and an elevated sedimentation rate. He was treated with steroids for polymyalgia rheumatica with improvement. He was subsequently admitted to the intensive care unit (ICU), where a diagnosis of Listeria monocytogenes sepsis was made and treated. With antibiotics he improved and was discharged from the hospital. This Case Report underscores the importance of considering unusual infections when entertaining a systemic autoimmune rheumatic disease (SARD) as the cause of systemic inflammatory response syndrome. 1 | Introduction Listeria monocytogenes (LM) infection is difficult to diagnose as it is an intracellular pathogen with a long incubation period that sometimes needs specialized testing to find. It is agram-positive, facultative anaerobic bacterium with a wide range of differential diagnosis, as it may be asymptomatic or self-limiting in immunocompetent people. In the immunocompromised population, it has a wide range of symptoms including systemic inflammatory response syndrome, which could be mistaken for a systemic autoimmune rheumatic disease such as polymyalgia rheumatica. It may even present as a severe infection, including meningitis or sepsis. LM is contracted via ingestion of contaminated foods, including raw milk products, smoked meats, and industrially processed vegetables. 2 | Case History/Examination A 70-year-old man presented to his primary care team with progressive myalgia and fatigue. The myalgias were worse in his shoulders and proximal muscles of his hip girdle. He also noted headaches, nasal congestion, and a loss of appetite. He had been diagnosed in the past with type 2 diabetes mellitus, coronary artery disease, chronic kidney disease stage 4, obstructive sleep apnea, gout, and gastroesophageal reflux disease. He was on allopurinol, colchicine, and atorvastatin 40 mg. He was a former smoker with a 40-pack-year history. There was significant tenderness of the shoulder and pelvic girdle musculature without joint swelling, redness, or warmth; his vital signs and physical examination were normal at the initial This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. © 2025 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. Clinical Case Reports, 2026; 14:e71765 1 of 3 [https://doi.org/10.1002/ccr3.71765](https://doi.org/10.1002/ccr3.71765) Key Clinical Message In older adults with symptoms and signs of systemic inflammatory response syndrome, infection must be carefully excluded before attributing symptoms to polymyalgia rheumatica or other rheumatic diseases. TABLE 1 | Laboratory results. | Laboratory tests | Day 1 | Day 30 | Reference range | | --- | --- | --- | ---

FAQs

Why was polymyalgia rheumatica initially considered in this case?

The patient had proximal muscle pain, fatigue, and elevated ESR and CRP, which commonly leads to an extensive evaluation and can support a PMR diagnosis when other causes are negative.

What ultimately changed the diagnosis?

Steroid therapy led to side effects and persistent elevations of inflammatory markers. Further investigation during later ICU care identified Listeria monocytogenes in blood culture and confirmed central nervous system infection.

What is the key clinical message of the report?

In older adults with systemic inflammatory response syndrome features, infection must be carefully excluded before attributing symptoms to PMR or other rheumatic diseases.

Sep 28, 2026

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