Reactions 1680, p281 - 2 Dec 2017 Legionella pneumophila infection: case report A 77-year-old woman developed Legionella pneumophila infection during treatment with prednisone [route not stated]. The woman had a history of non-insulin-dependent diabetes, hypertension and Graves’ disease. She presented with progressively worsening dyspnoea of one month. Two months before the presentation, she was diagnosed with giant cell arteritis and initiated on therapy with clopidogrel and prednisone 60mg daily, which was reduced to 10mg daily over the course of four weeks. At the time of presentation, she informed that she could not walk more than 10 steps without resting. Her exposure history was only significant for a recent trip to Florida where she stayed at a hotel. On admission, she was afebrile and in mild respiratory distress. Her resting heart rate 93 bpm, which increased to 124 bpm on minimal exertion. She was hypoxic on room air and required 3L of oxygen through a nasal cannula. The lungs auscultation demonstrated good air entry bilaterally without crackles. Lab findings revealed white cell count 8.7×10 /L, with neutrophil predominance, haemoglobin 12.6 g/dL, ALP 66 U/L, sodium of 127 mmol/L and aspartate aminotransferase 22 U/L. Chest X- ray described scattered infiltrates bilaterally. CT angiogram of the chest revealed patchy bilateral ground-glass opacities most prominent in the upper lobes [time to reaction onset not stated]. The woman’s received treatment with levofloxacin empirically. Flexible bronchoscopy with bronchoalveolar lavage (BAL) revealed normal appearing mucosa with minimal thin mucoid secretions throughout the bronchial tree and positive results for L. pneumophila via PCR. Legionella urinary antigen was also positive. A diagnosis of Legionella pneumophila infection was confirmed. Subsequently, her symptoms resolved and she was discharged. The BAL PCR result, urine antigen result and the response to levofloxacin therapy confirmed Legionella infection. Author comment: "Patients who are taking corticosteroids are at an increased risk to develop pulmonary infections". Albitar HAH, et al. Rare presentation of an old bug. BMJ Case Reports 2017: bcr-2017-220959, 19 Oct 2017. Available from: URL: http://doi.org/10.1136/ bcr-2017-220959 - Jordan 803284881 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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