Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Oct 16, 2019; 8(6): 99-105
Published online Oct 16, 2019. doi: 10.5492/wjccm.v8.i6.99
Fatal Legionella pneumophila serogroup 1 pleural empyema: A case report
François Maillet, Nicolas Bonnet, Typhaine Billard-Pomares, Fatma El Alaoui Magdoud, Yacine Tandjaoui-Lambiotte
François Maillet, Nicolas Bonnet, Yacine Tandjaoui-Lambiotte, Intensive Care Unit, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
Nicolas Bonnet, Paris XIII University, Bobigny 93000, France
Typhaine Billard-Pomares, Microbiology Department, Avicenne Hospital, Assistance Publique – Hôpitaux de Paris, Bobigny 93000, France
Fatma El Alaoui Magdoud, Microbiology Department, Jean Verdier Hospital, Assistance Publique–Hôpitaux de Paris, Bondy 93140, France
Author contributions: Maillet F drafted the manuscript and reviewed the literature. Bonnet N contributed to the manuscript drafting. Billard-Pomares T and El Alaoui Magdoud F performed microbiological analyses and interpretation and contributed to the manuscript drafting. Tandjaoui-Lambiotte Y contributed to the manuscript drafting, reviewed and analyzed the literature and was responsible of the manuscript’s revision. All authors issued final approval for the version to be submitted
Informed consent statement: Informed consent was not available due to the death of the patient. No family was available.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Yacine Tandjaoui-Lambiotte, MD, Doctor, Intensive Care Unit, Avicenne Hospital, APHP, 125 rue de Stalingrad, Bobigny 93000, France.
Telephone: +33-1-48955241 Fax: +33-1-48955090
Received: April 22, 2019
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.

Keywords: Legionella pneumophila serogroup 1, Legionellosis, Legionnaire’s disease, Pleural empyema, Case report

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.