Work

The Characteristic “Tunnel Sign” on MRI as a Diagnostic Marker of Tunneling Abscesses in Listeria Rhombencephalitis in a Patient With Multiple Myeloma: A Case Report

Year: 2026

Type: article

Abstract: Neurolisteriosis is a rare but potentially serious CNS infection. Diagnosis can be established through bacteriological studies or by identifying characteristic tunneling abscesses in the CNS. Delayed initiation of appropriate antibiotic therapy may result in permanent structural brain damage, disability, or death. We report the case of a 65-year-old woman with multiple myeloma undergoing chemotherapy who presented with an acute febrile illness accompanied by drowsiness, slurred speech, difficulty swallowing, neck stiffness, and complex ophthalmoplegia. MRI of the brain demonstrated characteristic findings of the “tunnel sign,” suggestive of a tunneling abscess in Listeria rhombencephalitis. The diagnosis was made based on radiological features alone, in the absence of microbiological confirmation. With prompt initiation of IV ampicillin, she demonstrated marked neurological recovery, with some residual deficits.

Source: Cureus

DOI: 10.7759/cureus.103000

Authors: Madhushan Ranabahu, Nipuna Weerasinghe, Janya Jayawardena, Kishan Dissanayake, Janaka Peiris

Institutions: Post Graduate Institute of Medicine, University of Colombo, Sri Lanka, University of Colombo, Teaching Hospital Kandy

Language: English

Topic: Infectious Diseases and Tuberculosis

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

OpenAlex ID: W7127890571