A patient presents with fever for 3 weeks. On examination he is observed to have splenomegaly. Ultrasonography reveals a hypoechoic shadow in spleen near the hilum. Gram-positive bacilli are isolated on blood culture. Which of the following is the most likely causative organism?
## **Core Concept**
The question describes a patient with prolonged fever, splenomegaly, and a hypoechoic lesion in the spleen, which are suggestive of a splenic abscess. A splenic abscess is a serious condition often caused by bacterial infections. The isolation of Gram-positive bacilli from the blood culture helps narrow down the possible causative organisms.
## **Why the Correct Answer is Right**
The correct answer, *Listeria monocytogenes*, is a Gram-positive bacillus known to cause infections that can lead to abscess formation in various organs, including the spleen, particularly in individuals with compromised immune systems. It is a common cause of bacteremia and can cause focal infections such as abscesses. The clinical presentation of prolonged fever, splenomegaly, and a hypoechoic shadow in the spleen near the hilum on ultrasonography, along with the isolation of Gram-positive bacilli on blood culture, aligns well with an infection caused by *Listeria monocytogenes*.
## **Why Each Wrong Option is Incorrect**
* **Option A:** *Streptococcus pneumoniae* is a Gram-positive coccus, not a bacillus, which does not match the Gram stain result provided.
* **Option B:** *Staphylococcus aureus* is a Gram-positive coccus, not a bacillus, and while it can cause abscesses, the Gram stain morphology does not fit.
* **Option D:** *Bacillus anthracis* is a Gram-positive bacillus but typically causes cutaneous anthrax or inhalational anthrax, and it is less commonly associated with the described clinical scenario of a splenic abscess.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that *Listeria monocytogenes* infections are more common in immunocompromised individuals, pregnant women, and neonates. When dealing with a patient with a splenic abscess caused by a Gram-positive bacillus, *Listeria monocytogenes* should be considered a potential causative organism, especially in the appropriate clinical context.
## **Correct Answer:** C. *Listeria monocytogenes*.