Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: case report and literature review - PubMed
Maria N Chitasombat 1 ,
Article ImagesReview
Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: case report and literature review
Maria N Chitasombat et al. BMC Infect Dis. .
Abstract
Background: Legionellosis is a well-known cause of pneumonia. Primary cutaneous and subcutaneous infection caused by Legionella pneumophila is rare and the diagnosis is challenging.
Case presentation: A 38-year-old Thai woman with systemic lupus erythematosus and myasthenia gravis treated with prednisolone and azathioprine presented to our hospital with low-grade fever, diarrhea, and indurated skin lesions on both thighs. Initial examination showed plaques on both inner thighs. Magnetic resonance imaging showed myositis and swelling of the skin and subcutaneous tissue. Diagnosis of panniculitis due to L. pneumophila was carried out by histopathology, Gram stain, and 16S rRNA gene sequencing method of tissue biopsy from multiple sites on both thighs. Myocarditis was diagnosed by echocardiography. The final diagnosis was disseminated extrapulmonary legionellosis. Treatment comprised intravenous azithromycin for 3 weeks and the skin lesions, myositis and myocarditis resolved. Oral azithromycin and ciprofloxacin were continued for 3 months to ensure eradication of the organism. The patient's overall condition improved.
Conclusions: To our knowledge, we report the first case of L. pneumophila infection manifesting with panniculitis, possible myositis, and myocarditis in the absence of pneumonia. The diagnosis of extrapulmonary Legionella infection is difficult, especially in the absence of pneumonia. A high index of suspicion and appropriate culture with special media or molecular testing are required. Initiation of appropriate treatment is critical because delaying therapy was associated with progressive infection in our patient.
Keywords: Legionella pneumophila; Lupus; Myocarditis; Myositis; Panniculitis.
Conflict of interest statement
Ethics approval and consent to participate
This study was approved by the Committee on Human Rights Related to Research Involving Human Subjects, Faculty of Medicine Ramathibodi Hospital, Mahidol University.
Consent for publication
The patient gave written consent for publication of her potentially identifying information (including individual details and images).
Competing interests
The authors declare that they have no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Figures
Similar articles
-
Tomizawa Y, Hoshino Y, Sasaki F, Kurita N, Kawajiri S, Noda K, Hattori N, Amemura-Maekawa J, Kura F, Okuma Y. Tomizawa Y, et al. Intern Med. 2015;54(23):3079-82. doi: 10.2169/internalmedicine.54.4872. Epub 2015 Dec 1. Intern Med. 2015. PMID: 26631897
-
Robbins NM, Kumar A, Blair BM. Robbins NM, et al. BMC Infect Dis. 2012 Sep 22;12:225. doi: 10.1186/1471-2334-12-225. BMC Infect Dis. 2012. PMID: 22998348 Free PMC article.
-
Cutaneous legionellosis: case report and review of the medical literature.
Padrnos LJ, Blair JE, Kusne S, DiCaudo DJ, Mikhael JR. Padrnos LJ, et al. Transpl Infect Dis. 2014 Apr;16(2):307-14. doi: 10.1111/tid.12201. Epub 2014 Mar 17. Transpl Infect Dis. 2014. PMID: 24628820 Review.
-
Case of Infantile Legionella Pneumonia After Bathing in Reheated and Reused Water.
Tomari K, Morino S, Horikoshi Y. Tomari K, et al. Pediatr Infect Dis J. 2018 Apr;37(4):370-372. doi: 10.1097/INF.0000000000001755. Pediatr Infect Dis J. 2018. PMID: 28859016
-
Shimura C, Saraya T, Wada H, Takata S, Mikura S, Yasutake T, Kato J, Kato A, Yamamoto M, Watanabe M, Yokoyama T, Kurai D, Ishii H, Aoshima M, Yamada A, Goto H. Shimura C, et al. J Clin Pathol. 2008 Sep;61(9):1062-3. doi: 10.1136/jcp.2008.057000. Epub 2008 Jun 13. J Clin Pathol. 2008. PMID: 18552170 Review.
Cited by
-
Legionella lymphadenitis in immunocompetent adult: Case report.
Salem J, Fares F, El-Haddad R, Fares M, El-Helou G. Salem J, et al. IDCases. 2024 Jul 2;37:e02023. doi: 10.1016/j.idcr.2024.e02023. eCollection 2024. IDCases. 2024. PMID: 39109187 Free PMC article.
-
Li S, Jiang W, Wang CY, Weng L, Du B, Peng JM. Li S, et al. Front Med (Lausanne). 2022 Sep 26;9:955955. doi: 10.3389/fmed.2022.955955. eCollection 2022. Front Med (Lausanne). 2022. PMID: 36226140 Free PMC article.
-
Gattuso G, Rizzo R, Lavoro A, Spoto V, Porciello G, Montagnese C, Cinà D, Cosentino A, Lombardo C, Mezzatesta ML, Salmeri M. Gattuso G, et al. Antibiotics (Basel). 2022 Mar 9;11(3):370. doi: 10.3390/antibiotics11030370. Antibiotics (Basel). 2022. PMID: 35326833 Free PMC article. Review.
-
Trousil J, Frgelecová L, Kubíčková P, Řeháková K, Drašar V, Matějková J, Štěpánek P, Pavliš O. Trousil J, et al. Microorganisms. 2022 Jan 14;10(1):179. doi: 10.3390/microorganisms10010179. Microorganisms. 2022. PMID: 35056629 Free PMC article.
-
Legionnaires' disease presenting with exanthem; Case and review of previously published cases.
Carter CJ, Corley EM, Canepa H, Schmalzle SA. Carter CJ, et al. IDCases. 2022 Jan 3;27:e01376. doi: 10.1016/j.idcr.2022.e01376. eCollection 2022. IDCases. 2022. PMID: 35028294 Free PMC article.
References
-
- Bodur H., Savran Y., Koca U., Kilinç O., Albayrak S., Itil O., Akoğlu S. Legionella pneumonia with acute respiratory distress syndrome, myocarditis and septic shock successfully treated with Drotrecogin Alpha (activated) European Journal of Anaesthesiology. 2006;23(9):808–810. doi: 10.1017/S0265021506221252. - DOI - PubMed
-
- Sommer JB, Erbguth FJ, Neundorfer B. Acute disseminated encephalomyelitis following Legionella pneumophila infection. Eur Neurol. 2000;44(3):182–4. - PubMed
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical