Legionella lymphadenitis in immunocompetent adult: Case report

Abstract

Introduction: Extrapulmonary legionella disease is rare and occasionally reported in immunocompromised patients; it includes lymphadenitis, panniculitis, hepatitis, atrio-ventricular block, arthritis, prosthetic valve endocarditis and myocarditis. In this article, we report a rare case of legionella suppurative lymphadenitis in an immunocompetent patient. Case: 53-year-old female patient from the Philippines, non-smoker, previously healthy who presented to our facility for chills and respiratory distress following a course of corticosteroid intake. She was admitted for respiratory failure and septic shock, and was diagnosed with legionella infection associated with extrapulmonary dissemination (lymphadenitis) leading to her death 72 h after admission. Discussion: Legionella is an important cause of community acquired pneumonia (CAP) and a delay in appropriate antibiotic therapy was associated with an increased mortality rate. Since legionnaire's disease is indistinguishable from other forms of pneumonia without diagnostic testing, empiric antibiotic therapy regimen should cover legionella species. In unfortunate cases, a delay in the diagnosis and treatment may lead to extrapulmonary manifestations such as lymphadenitis and will be associated with worse patient outcomes. Conclusion: Legionella is an important cause of community acquired pneumonia which if left untreated can become complicated with extrapulmonary manifestations such as lymphadenitis and become eventually fatal to patients. A prompt early diagnosis and appropriate antimicrobial therapy covering legionella should be considered whenever treating community acquired pneumonia.