Legionnaires' Disease with Hypoperfusion in the Cerebellum and Frontal Lobe on Single Photon Emission Computed Tomography

Imai, Noboru; Yagi, Nobuyasu; Konishi, Takashi; Serizawa, Masahiro; Kobari, Masahiro

doi:10.2169/internalmedicine.47.0857

Cited by 20 publications

(8 citation statements)

References 15 publications

(2 reference statements)

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“…Even in the presence of these symptoms, computed tomography (CT) scans of the brain often appear to be normal, and magnetic resonance imaging (MRI) seldom reveals brain lesions. In a previous case, Imai et al reported that single-photon emission computed tomography (SPECT) using technetium-99m-hexamethyl-propylene amine oxime revealed brain lesions in a patient with Legionnaires' disease accompanied by CNS symptoms [ 4 ]. Here, we report our experience with 2 cases of Legionnaire pneumophila pneumonia with prolonged neurologic symptoms.…”

Section: Introductionmentioning

confidence: 99%

Two Cases ofLegionella pneumophilaPneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography

Ohta

Yamazaki

Miura

et al. 2016

Case Reports in Infectious Diseases

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Cerebral and cerebellar symptoms are frequently associated with Legionnaires' disease. However, corresponding brain lesions are difficult to demonstrate using either computed tomography (CT) or magnetic resonance imaging (MRI). We report here two patients with Legionella pneumophila pneumonia accompanied by prolonged neurologic symptoms. In contrast to brain CT and MRI, which failed to detect any abnormalities, single-photon emission computed tomography (SPECT) showed multiple sites of hypoperfusion within the brains of both patients. These cases suggest that vasculopathy, which is detectable by SPECT, might be one of the causes of neurologic symptoms in patients with Legionnaires' disease.

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Section: Introductionmentioning

confidence: 99%

Two Cases ofLegionella pneumophilaPneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography

Ohta

Yamazaki

Miura

et al. 2016

Case Reports in Infectious Diseases

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“…Given the anatomy of this lesion, it is unlikely that it was responsible for the patient’s speech abnormality. While recent reports with single-photon emission CT have demonstrated that hypoperfusion of the brain can persist for weeks in patients with neurological symptoms and Legionella pneumonia 13. In our case, further functional imaging and repeat MRI was not pursued due to improvement in the patient’s symptoms.…”

Section: Discussionmentioning

confidence: 70%

Transient parkinsonism associated with acute Legionnaires’ disease

Honsberger

Husnain

2020

BMJ Case Rep

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A 44-year-old right-handed man with a 5-day history of non-productive cough associated with subjective fevers/chills and night sweats presented to the emergency department with slurred speech. Radiography and urine antigen testing confirmed the diagnosis of Legionella pneumonia. The hospital course was complicated by acute hypoxic respiratory failure that required 7 days of invasive mechanical ventilation. Following extubation, the patient had dysarthria and developed new parkinsonism features. Brain imaging revealed a non-specific focal lesion in the left frontal lobe of unclear significance. Ciprofloxacin was decided as the final antibiotic of choice for its favourable central nervous system profile. Levodopa–carbidopa was initiated to help activate the basal ganglia. The patient had complete resolution of pneumonia and transient parkinsonism. He was able to regain most of his baseline functional status with intensive rehabilitation.

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“…Because of this apparent contradiction, Morgan et al postulated that additional areas of the brain may be affected even if MRI cannot detect involvement [4]. Working on this hypothesis, Imai and colleagues found evidence of diffuse cerebellar and frontal lobe hypoperfusion on single photon emission CT in a patient with Legionella pneumonia who presented similarly to the patient described in the case study: respiratory symptoms, confusion, dysarthria, and an isolated hyperintense reversible SCC lesion on MRI diffusion-weighted imaging (DWI) [37]. It remains to be seen what significance these radiologic findings hold for the diagnosis and treatment of the Legionella or the other entities listed above, but clearly more research is needed in order to understand the utility of this radiologic abnormality in diagnosing and prognosticating encephalopathy.…”

Section: Discussionmentioning

confidence: 99%

Legionella pneumophila infection presenting as headache, confusion and dysarthria in a human immunodeficiency virus-1 (HIV-1) positive patient: case report

2012

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BackgroundLegionella pneumophila is a common cause of community-acquired pneumonia. Central nervous system dysfunction is common, and diagnosis in the absence of pulmonary symptoms can be challenging. Here we describe an atypical clinical presentation of Legionella infection in a patient with HIV who was found to have an unusual neuroradiologic lesion that further served to obscure the diagnosis. This is the first such description in a patient with Legionellosis and HIV coinfection.Case presentationA 43 year-old HIV positive man presented to our hospital with dysarthria, fevers, headache, and altered mental status. Initial work-up revealed pneumonia and a lesion of the splenium of the corpus callosum on magnetic resonance imaging. He was subsequently diagnosed with Legionella pneumonia and treated with complete symptom resolution.ConclusionsNeurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of HIV coinfection. A high index of suspicion and early initiation of empiric antibiotics is imperative since early treatment may help prevent long-term sequelae. Neuroimaging abnormalities, though rare, can help the physician narrow down the diagnosis and avoid unnecessary invasive testing. Future studies should aim to elucidate the as yet unknown role of neuroimaging in the diagnoses and prognostication of Legionellosis, as well as the interaction between Legionella infection and HIV.

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Legionnaires' Disease with Hypoperfusion in the Cerebellum and Frontal Lobe on Single Photon Emission Computed Tomography

Abstract: Abstract

Cited by 20 publications

References 15 publications

Two Cases ofLegionella pneumophilaPneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography

Two Cases ofLegionella pneumophilaPneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography

Transient parkinsonism associated with acute Legionnaires’ disease

Legionella pneumophila infection presenting as headache, confusion and dysarthria in a human immunodeficiency virus-1 (HIV-1) positive patient: case report

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