This woman made a good postoperative recovery with 14 days of intensive care unit/high dependency unit care. She was extubated on day 1 after her operation and was quickly alert and oriented. Her inflammatory markers rapidly normalised after surgery. Recovery was only complicated by a persistent acidosis and hyperchloraemia which corrected with supportive management.
Histology found a gall bladder specimen with a 6 mm stone in the lumen and wall thickness of 2–3 mm. The mucosa was irregular with focal superficial ulceration, chronic mucosal inflammation, muscle hyperplasia and Rokitansky–Aschoff sinus formation, all consistent with chronic cholecystitis and cholelithiasis.
Microbiological analysis of the gall bladder did not culture L monocytogenes from the sample.
Subsequent investigation for HIV associated infections confirmed cytomegalovirus (CMV) infection (CMV DNA PCR 797 copies/ml) and ophthalmology found possible early changes of CMV retinitis. Toxoplasma, hepatitis viruses and syphilis were negative.
Given her CD4 count of 84/mm3, the patient was treated with prophylactic cotrimoxazole 480 mg once daily and oral antiretroviral therapy consisting of tenofavir disoproxil 245 mg once daily, emtricitabine 200 mg once daily and efavirenz 600 mg once daily.
Having made a successful recovery from her cholecystitis and listeriosis, this woman was transferred to a tertiary referral centre for specialist care of her acquired immunodeficiency syndrome.