Korean J Infect Dis.  1998 Feb;30(1):106-110.

A Case of Fatal Nosocomial Legionnaires' Disease by Legionella pneumophila Serogroup 1

• Kim KB
• Kang MS
• Chung HJ
• Woo HJ
• Kim MJ
• You SH
• Park SC

Abstract

Nosocomial Legionnaires' disease has often been documented to occur in immunocompromised patients and to be severe, potentially fatal, pneumonia. We report a case of fatal nosocomial Legionnaires' disease developed shortly after steroid pulse therapy. A 39-year old woman with systemic lupus erythematosus was admitted via emergency room due to generalized edema and gross hematuria. Under the diagnosis of lupus nephritis, she was given intravenous steroid pulse therapy for 3 days and then maintained with oral prednisolone. On the 7th day of admission the patient's conditions got worse with progression to acute renal failure and respiratory difficulty. On the 10th day of admission when she was started on hemodialysis, chestradiograph showed newly developed multifocal mass-like consolidations on both lung fields. In spite of empirical therapy with roxithromycin and rifampin, the consolidations were aggravated and rapidly extended to both whole lung fields. On the 15th day of admission she was mechanically ventilated due to respiratory failure, but died of hypoxia and shock on the 19th day. Later, a legionella species was isolated from the tracheal aspirates and identified as L. pneumophila serogroup 1. We also detected L. pneumophila from the tracheal aspirates by duplex PCR which amplified both 5S rRNA and mip genes of L. pneumophila.

Keyword

Nosocomial pneumonia; Fatal; Legionella pneumophila; Steroid

MeSH Terms

Acute Kidney Injury
Adult
Anoxia
Diagnosis
Edema
Emergency Service, Hospital
Female
Hematuria
Humans
Immunocompromised Host
Legionella pneumophila*
Legionella*
Legionnaires' Disease*
Lung
Lupus Erythematosus, Systemic
Lupus Nephritis
Pneumonia
Polymerase Chain Reaction
Prednisolone
Renal Dialysis
Respiratory Insufficiency
Rifampin
Roxithromycin
Shock
Prednisolone
Rifampin
Roxithromycin