Two Cases of<i>Legionella pneumophila</i>Pneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography

Ohta, Hiromitsu; Yamazaki, Susumu; Miura, You; Seto, Akira; Kanazawa, Minoru; Nagata, Michio

doi:10.1155/2016/5264681

Cited by 3 publications

(5 citation statements)

References 12 publications

(14 reference statements)

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“…There has been some evidence that SPECT may be the superior imaging modality for neurologic sequelae of Legionella as there have been cases where SPECT has picked up prolonged cerebellar hypoperfusion not seen on MRI. This also provides evidence for the immune-mediated mechanism as this pattern seen on SPECT is similar to what has been seen on SPECT in CNS lupus patients [13]. Advanced imaging was not performed on our patient because his cerebellar dysfunction showed significant clinical improvement prior to discharge.…”

Section: Discussionsupporting

confidence: 78%

A Unique Presentation of Extrapulmonary Legionella: Rhabdomyolysis-Induced Acute Renal Failure and Cerebellar Dysfunction

Olson¹,

Murshad²,

Amin³

et al. 2022

Cureus

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Legionella is most known for causing pneumonia. However, it is a systemic disease that can directly cause severe multi-organ injury in what is sometimes referred to as "extrapulmonary Legionella." In this case report, a reasonably healthy 80-year-old man is found to have Legionella pneumonia complicated by rhabdomyolysis with acute, severe, non-oliguric acute kidney injury, uremic encephalopathy, transaminitis, and cerebellar dysfunction. With a 14-day course of azithromycin and prompt initiation of dialysis, the patient’s pneumonia and systemic sequelae improved. This case demonstrates the importance of considering Legionella in the differential diagnosis of patients who present with community-acquired pneumonia and multi-organ dysfunction. Prompt diagnosis and management may decrease mortality associated with this disease sequela.

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Section: Discussionsupporting

confidence: 78%

A Unique Presentation of Extrapulmonary Legionella: Rhabdomyolysis-Induced Acute Renal Failure and Cerebellar Dysfunction

Olson¹,

Murshad²,

Amin³

et al. 2022

Cureus

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“…In both patients, as with ours, CT and MRI were normal. Single-photon emission computed tomography (SPECT) imaging was obtained which showed hypoperfusion to cerebellar, and frontal lobes, but unfortunately we did not obtain SPECT imaging for our patient 4. Kunimasa et al reported a case of L egionella pneumonia where diffusion-weighted MRI showed marked hyperintensities in the corpus callosum on day 2 of presentation, which resolved after 2 weeks 5.…”

Section: Discussionmentioning

confidence: 80%

“…Ohta et al described two patients with Legionella pneumonia that manifested as prolonged neurologic deficits 4. The first patient exhibited difficulty in walking and was unable to stand on his own.…”

Section: Discussionmentioning

confidence: 99%

Cerebellar ataxia a unique initial presentation of Legionnaires’ disease

et al. 2020

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We present a case of Legionnaires’ disease complicated by cerebellar ataxia. A 60-year-old man was diagnosed with Legionnaires’ disease by urine antigen after presenting to the hospital with a main problem of headache and gait instability. He also had a productive cough, as well as nausea, vomiting and diarrhoea. Initial physical examination revealed a positive Romberg test, positive pronator drift, severely unsteady gait and bilateral upper extremity resting tremors with the remainder of cranial nerves and neurological examination being unremarkable. The patient had a prolonged hospital course requiring endotracheal intubation and mechanical ventilation. He received 14 days of levofloxacin with resolution of the pneumonia. On repeat assessment prior to discharge, the patient’s neurological symptoms improved; however, he still had mild residual gait instability, dysdiadokinesia and difficulty with fine motor tasks such as writing. Romberg test remained positive.

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“…Legionella is unique due to its ability to present with a variety of different clinical presentations which can include significant neurological findings. These findings can consist of cerebral symptoms including confusion and cerebellar symptoms including gait, limb ataxia, and dysarthria [3]. The onset of neurological symptoms is roughly five days post pneumonic symptoms [6].…”

Section: Discussionmentioning

confidence: 99%

“…It commonly presents as an atypical lower respiratory illness, however can lead to multi-organ involvement with a mortality of 60-70% without antibiotic therapy and 10-20% with therapy [2]. It can present with a wide-range of symptoms involving the renal, hepatic, gastrointestinal, and neurologic systems [3]. Legionella can manifest with neurological symptoms, however having an isolated neurological presentation is rare.…”

Section: Introductionmentioning

confidence: 99%

A Prolonged Neurological Presentation of Legionnaire's Disease

Patel

Sharma

Attarha

et al. 2021

Cureus

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Legionnaire's disease is an uncommon pneumonic disease that can carry a mortality rate up to 20%. It commonly presents as an atypical lower respiratory illness. However, it is important to be mindful of the various extra-pulmonic presentations of the infection. Here, we present a case of a 51-year-old female who presented to the emergency department with lethargy, slurred speech, and confusion. Legionella has been reported to present with neurological symptoms but it is not a common occurrence in each hospitalization. These neurological symptoms often lead to an extensive workup and the complexity of the diagnostic workup can significantly influence patient outcome. However, it is crucial that physicians follow a systemic approach to establish a diagnosis in an expedited manner. This case emphasizes the importance of key objective evidence of legionella that can help guide a physician's diagnostic approach.

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

Cited by 3 publications

References 12 publications

A Unique Presentation of Extrapulmonary Legionella: Rhabdomyolysis-Induced Acute Renal Failure and Cerebellar Dysfunction

A Unique Presentation of Extrapulmonary Legionella: Rhabdomyolysis-Induced Acute Renal Failure and Cerebellar Dysfunction

Cerebellar ataxia a unique initial presentation of Legionnaires’ disease

A Prolonged Neurological Presentation of Legionnaire's Disease

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