Published online Oct 16, 2019. doi: 10.5492/wjccm.v8.i6.99
Peer-review started: April 23, 2019
First decision: August 1, 2019
Revised: August 29, 2019
Accepted: September 9, 2019
Article in press: September 9, 2019
Published online: October 16, 2019
Legionella pneumophila (L. pneumophila) is a gram-negative intracellular bacillus composed of sixteen different serogroups. It is mostly known to cause pneumonia in individuals with known risk factors as immunocompromised status, tobacco use, chronic organ failure or age older than 50 years. Although parapneumonic pleural effusion is frequent in legionellosis, pleural empyema is very uncommon. In this study, we report a case of fatal pleural empyema caused by L. pneumophila serogroup 1 in an 81-year-old man with multiple risk factors.
An 81-year-old man presented to the emergency with a 3 wk dyspnea, fever and left chest pain. His previous medical conditions were chronic lymphocytic leukemia, diabetes mellitus, chronic kidney failure, hypertension and hyperlipidemia, without tobacco use. Chest X-ray and comouted tomography-scan confirmed a large left pleural effusion, which puncture showed a citrine exudate with negative standard bacterial cultures. Despite intravenous cefotaxime antibiotherapy, patient’s worsening condition after 10 d led to thoracocentesis and evacuation of 2 liters of pus. The patient progressively developed severe hypoxemia and multiorgan failure occurred. The patient was treated by antibiotherapy with cefepime and amikacin and with adequate symptomatic shock treatment, but died of uncontrolled sepsis. The next day, cultures of the surgical pleural liquid samples yielded L. pneumophila serogroup 1, consistent with the diagnosis of pleural legionellosis.
L. pneumophila should be considered in patients with multiple risk factors and undiagnosed pleural empyema unresponsive to conventional antibiotherapy.
Core tip: Legionella pneumophila (L. pneumophila) is a gram-negative bacillus known as a common cause of pneumonia, with frequent parapneumonic pleural effusion. In contrast, pleural empyema seems very uncommon. We report here the case of an 81-year-old man with multiple comorbidities who presented with a large left pleural effusion. Despite wide antibiotic courses against extracellular bacteria associated to surgical thoracentesis, patient died of uncontrolled septic shock. L. pneumophila serogroup 1 was isolated from the surgical pleural liquid sample, consistent with a pleural localization of Legionnaire’s disease. We therefore would emphasize that L. pneumophila is an exceptional cause of pleural empyema in patients with multiple risk factors.