Legionellosis presenting as singultus and external ophthalmoplegia

Konno, Shingo; Kono, Haruhi; Kitazono, Hisao; Murata, Mayumi; Nakazora, Hiroshi; Nomoto, Nobuatsu; Sugimoto, Hideki; Sanno, Ken; Fujioka, Toshiki

doi:10.1007/s10072-011-0927-3

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…The patients previously described were older than 70 years of age (with the exception of one younger individual). Hiccups subsided only after the infective trigger was treated, and the most important feature, lung lesion was on the right side 4–8…”

Section: Discussionmentioning

confidence: 99%

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Rare clinical manifestation of community-acquired pneumonia

Brikman

Levi

Dori³

2018

BMJ Case Rep

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A 71-year-old patient was admitted due to fever and persistent (>48 hours) hiccups. History and physical examination were not instructive. Lab tests were not specific, showing an inflammatory response. Chest film did not demonstrate opacities. The patient was treated with chlorpromazine with no relief. Fever and hiccups persisted, and therefore neck and chest CT was performed revealing a right lower lobe infiltrate, a finding consistent with pneumonia. Antibiotics were initiated and within 48 hours fever and hiccups resolved and patient recovered. Although hiccups are rarely described as a clinical manifestation of community acquired pneumonia, one should consider this diagnosis in a patient with unexplained fever.

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Section: Discussionmentioning

confidence: 99%

“…A review of the literature (PUBMED search included: Pneumonia and (singultus or hiccups)) reveals only four reported cases in the past 15 years of lung infection/pneumonia presenting with hiccups (table 1). 4–7…”

Section: Introductionmentioning

confidence: 99%

Rare clinical manifestation of community-acquired pneumonia

Brikman

Levi

Dori³

2018

BMJ Case Rep

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“…Although such lesions have been described in patients with hypoglycemia or hypernatremia, no reports have described them in patients with Legionnaires' disease. These magnetic resonance imaging findings show that cytotoxic edema and Legionella endotoxicity could cause these lesions …”

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confidence: 85%

Reversible diffusion hyperintensity of bilateral pyramidal tracts and the corpus callosum in Legionnaires' disease

Yoshida

Endo

Konno

et al. 2014

Neurology & Clinical Neurosc

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Reversible diffusion hyperintensity of bilateral pyramidal tracts and the corpus callosum in Legionnaires' disease A healthy 36-year-old man was admitted to Sendai City Hospital, Miyaki, Japan, with disturbance of consciousness after 3 days of high fever. Laboratory values showed mild hyponatremia (132 mEq/L), thrombocytopenia and high levels of creatine kinase. Chest computed tomography showed consolidation of the left lower lobe. Brain magnetic resonance imaging showed diffusion hyperintensity in bilateral pyramidal tracts and the corpus callosum, with a reduced apparent diffusion coefficient. Legionella urinary antigen testing showed positive results. The patient was treated using antibiotics supported by non-invasive positive pressure ventilation. After 6 days of hospitalization, the fever resolved and the patient's level of consciousness improved. Brain lesions were resolved on repeat magnetic resonance imaging 18 days later (Fig. 1).Although such lesions have been described in patients with hypoglycemia or hypernatremia, 1 no reports have described them in patients with Legionnaires' disease. These magnetic resonance imaging findings show that cytotoxic edema and Legionella endotoxicity could cause these lesions. 2 AcknowledgmentThe authors declare that they have no conflict of interest. References

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“…Eventuell handelt es sich hier um eine indirekte Aktivierung des zentralen Schluckaufzentrums durch aufsteigende Bahnen oder zirkulieren-de Antikörper. Eine solcher immunvermittelter Schluckauf wurde auch von Autoren vermutet, die einen Singultus mit anderen Hirnstammsymptomen bei einem Patienten mit Legionellose vorfanden [49]. Auch historisch wurden Assoziationen von entzündlichen ZNS-Erkrankungen mit Schluckauf berichtet.…”

Section: Singultus Bei Läsionen Des Zentralen Nervensystemsunclassified

Singultus – Diagnostik und Therapie

Ohlrich¹,

Royl²

2017

Laryngo-Rhino-Otol

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A hiccup is a reflex movement with diffusely distributed afferents and efferents in the thorax; its functional relevance is controversial. In its physiological form, it is mostly a minor complaint that stops spontaneously and rarely leads to medical consultation. However, prolonged agonizing hiccups represent serious deterioration of quality of life. Chronic hiccups by definition last for more than 48 h, with gastroesophageal reflux being the frequent underlying disease. Various other causes affect multiple organ systems, some with serious underlying diseases. A hiccup may be the only symptom at the first manifestation of some neurological disorders. In neuroimaging a lesion of the medulla oblongata is often seen. A NMO and an ischemic stroke with Wallenberg syndrome are 2 frequently underlying neurological diseases, but other inflammatory and vascular diseases and tumors of the central nervous system may be present. No optimal evidencebased recommendations for diagnosis and management of chronic hiccups are available. The search for the underlying disease often requires an interdisciplinary approach by internists, neurologists, and otolaryngologists. Symptomatic treatment may be necessary even before diagnosis. Persistent hiccups, a common problem in oncological palliative care, are often challenging. Proton pump inhibitor or prokinetics are used for treating underlying gastroesophageal reflux and baclofen with or without gabapentin in other cases. Anticonvulsants, antipsychotics, antidepressants, and calcium channel blockers represent other alternative treatment possibilities. In therapy-refractory cases, invasive procedures such as the selective phrenic nerve block are available. More studies are needed to help deal with the diagnostic and therapeutic challenge that hiccups present for neurologists.

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Legionellosis presenting as singultus and external ophthalmoplegia

Cited by 8 publications

References 18 publications

Rare clinical manifestation of community-acquired pneumonia

Rare clinical manifestation of community-acquired pneumonia

Reversible diffusion hyperintensity of bilateral pyramidal tracts and the corpus callosum in Legionnaires' disease

Singultus – Diagnostik und Therapie

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