Medical treatment failure and complete left pneumonectomy after Legionella pneumophila pneumonia in a bone marrow transplant recipient.

Legionnaire disease (LD) is infrequently considered in the differential diagnoses for hospital- and community-acquired pneumonia in pediatrics. We report a case of Legionnaire disease in a 19-year-old male with aplastic anemia after bone marrow transplant, who was being treated in a children's hospital. Severe, refractory pulmonary disease necessitated pneumonectomy to control the infection.

Legionella pneumophila lung abscess associated with immune suppression.

Legionella species are a common cause of community-acquired pneumonia, infrequently complicated by cavitary disease. We describe Legionella pneumophila pneumonia and abscess formation in an immunosuppressed patient receiving corticosteroid therapy for metastatic breast carcinoma. The predisposing role of corticosteroids is discussed and the management of this complication is reviewed.

Disseminated Legionella pneumophila infection in an immunocompromised patient treated with tigecycline.

We describe an immunocompromised patient with disseminated Legionella pneumophila infection. A chronic leg ulcer was probably the port of entry for the infection. Treatment required several operations and prolonged antimicrobial treatment. To our knowledge, this is the first case report of Legionella soft tissue infection and pneumonia treated with tigecycline.

Legionella pneumophila aortitis in a heart transplant recipient.

We describe the case of a patient with a culture-proven infection of the ascending aorta caused by Legionella pneumophila 16 months after cardiac transplantation. Serology follow-up and surveillance culture of the hospital water supply suggested a nosocomial acquisition of the infection during the post-transplantation period. The diagnosis was made after 5 months of recurrent unexplained febrile episodes. A Teflon ring implanted around the aortic suture line during the intervention may have contributed to the unusual localization of the infection. The patient was successfully treated with antibiotics and aortic reconstruction.

Legionella pneumophila serogroup 4 isolated from joint tissue.

We report the isolation of Legionella pneumophila serogroup 4 from synovial tissue obtained from an 80-year-old female with chronic swelling of her right metacarpophalangeal joint. Synovial tissue infections caused by L. pneumophila are rare. Interestingly, this isolate was recovered from chocolate agar after 5 days of incubation.

Prosthetic valve endocarditis due to Legionella pneumophila.

Prosthetic valve endocarditis is a potential complication of valve replacement surgery and warrants prompt diagnosis and appropriate treatment. Thus, the blood culture in addition to providing an etiological organism is important in establishing appropriate antibiotic therapy. A case of prosthetic valve endocarditis (PVE) is presented with repeatedly negative blood cultures at a community hospital and refractory to prolonged therapy with standard antibiotic regimens. Appropriate workup eventually identified the causative organism as Legionella pneumophila, and antimicrobial therapy directed against Legionella combined with a repeat valve replacement effectively treated this case. Aspects of culture-negative PVE including the microbiology and etiology are discussed. Legionella endocarditis represents an important cause of culture negative PVE and should be considered in the differential diagnosis of culture negative PVE refractory to standard antimicrobial therapy.

[Legionnaires' disease with mediastinal lymph nodes swelling, diagnosed by open lung biopsy--a case report].

Legionnaires' disease in a 37-year-old male who had had silicosis was reported. He was admitted because of dyspnea. The chest X-ray film and CT scan showed infiltrative shadow and swelling of mediastinal lymph nodes. Open lung biopsy was done and Legionella pneumohila was detected. REP and EM were started and infiltrative shadow of X-ray was disappeared. Pleuro-pneumonectomy and thoracoplasty were performed because of hemoptysis and postoperative empyema. The patient is now well.