Legionella Causing Lung Abscess in an Immunocompetent Patient

Rohan Madhu Prasad^1, , Fazal Raziq¹, Tyler Kemnic¹, Muhammad Nabeel¹ and Madeeha Ghaffar²

¹Department of Internal Medicine, Michigan State University - Sparrow Hospital, Lansing, Michigan, United States

²Bachelors of Science, Fatima Jinnah Medical University, Lahore, Pakistan

Cite this paper:
Rohan Madhu Prasad, Fazal Raziq, Tyler Kemnic, Muhammad Nabeel and Madeeha Ghaffar. Legionella Causing Lung Abscess in an Immunocompetent Patient. American Journal of Medical Case Reports. 2021; 9(1):18-21. doi: 10.12691/ajmcr-9-1-6

Abstract

Legionella lung abscess (LLA) is known to develop from pneumonia and Legionnaires’ disease in immunocompromised patients and aspiration. Literature review showed reports of aspiration pneumonia in immunocompetent patients; however, no such was found between LLA and immunocompetency. A 53-year-old male with history of depression and paraumbilical hernia presented for chest pain, which was right sided, started acutely, constant, radiated to the back, and exaggerated with taking deep breaths. The patient denied all other symptoms. Social history was only pertinent for being an active 35 pack-year smoker. The patient was recently admitted one month ago for viral meningitis from Echovirus. On physical exam, the patient was vitally stable, had absent breath sounds in the right middle lobe, and was significantly tender at the right anterior chest. Labs revealed elevated sedimentation rate and C-reactive protein. Imaging demonstrated a right middle lobe lung abscess. Throughout the hospital course, Legionella pneumophila serogroup 1 (LPS1) was found to be positive on urine antigen, sputum polymerase chain reaction, and sputum cultures. The patient was switched to intravenous levofloxacin and ampicillin-sulbactam. Upon symptomatic resolution, the patient was discharged home with recommendations for a follow-up chest computed tomography and diagnostic bronchoscopy. We hypothesize that smoking causes neutrophilic stasis within the lung and the development of the LLA. Treatment includes intravenous long term antibiotics and possibly drainage.

Keywords:
case report Legionella pneumophila infection lung abscess Immunocompetence cigarette smoking

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References:

[1]	Kuhajda L, Zarogoulidis K, Tsirgogianni K, et al. Lung abscess-etiology, diagnostic, and treatment options. Ann Transl Med. 2015, 3: 183-192.
[2]	Fields BS, Benson RF, Besser RE. Legionella and Legionnaires’ disease: 25 years of investigation. Clin Microbiol Rev. 2002, 15: 506-526.
[3]	Yu VL, Plouffe JF, Pastoris MC, et al. Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis. 2002, 186: 127-128.
[4]	Ebright J, Tarak E. Multiple bilateral lung cavities caused by Legionella pneumophila: case report and review. Infect Dis Clin Prac. 1993, 2: 195-199.
[5]	Senecal JL, St-Antoine P, Bacliveau C. Legionella pneumophila lung abscess in a patient with systemic lupus erythematosus. Am J Med Sci. 1987, 293: 309-314.
[6]	Yu H, Higa F, Koide M, et al. Lung abscess caused by Legionella species: implication of the immune status of hosts. Internal Medicine. 2009, 48: 1997-2002.
[7]	Stern RC, Berkowitz RJ, Shurin SB, Sorensen RU, Haaga JR. Multiple microaerophilic streptococcal lung abscesses after orthodontic treatment. Pediatrics. 1982, 70: 722-724.
[8]	Hayashi S, Naitoh K, Matsubara S, et al. Pulmonary colonization by Chrysosporium zonatum associated with allergic inflammation in an immunocompetent subject. J Clin Microbiol. 2002, 40: 1113-1115.
[9]	Gera K, Roshan R, Varma-Basil M, Shah A. Chronic pneumonia due to Klebsiella oxytoca mimicking pulmonary tuberculosis. Pneumonol Alergol Pol. 2015, 83: 383-386.
[10]	Marco A, Solé R, Raguer E, Aranda M. Goma o absceso tuberculoso metastásico como diagnóstico inicial de tuberculosis en un paciente inmunocompetente: una presentación inusual [Tuberculous gumma or metastatic tuberculous abscess as initial diagnosis of tuberculosis in an immunocompetent patient: an unusual presentation]. Rev Esp Sanid Penit. 2014, 16: 59-62.
[11]	Gump DW, Frank RO, Winn WC Jr, Foster RS Jr, Broome CV, Cherry WB. Legionnaires’ disease in patients with associated serious disease. Ann Intern Med. 1979, 90: 538-542.
[12]	Chow JW, Yu VL. Legionella: a major opportunistic pathogen in transplant recipients. Semin Respir Infect. 1998, 13: 132-139.
[13]	Edelstein PH. Antimicrobial chemotherapy for legionnaire’s disease: a review. Clin Infect Dis. 1995, 21: 5265-5276.
[14]	Schindel C, Siepmann U, Han S, et al. Persistent Legionella infection in a patient after bone marrow transplantation. J Clin Microbiol. 2000; 38: 4294-4295.
[15]	Mandell LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of america/american thoracic society of consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007, 44: S27-72.
[16]	MacNee W, Wiggs B, Belzberg A, Hogg JC. The effect of cigarette smoking on neutrophil kinetics in human lungs. N Engl J Med. 1989, 321: 924-928.
[17]	Guy SD, Worth LJ, Thursday KA, Francis PA, Slavin MA. Legionella pneumophila lung abscess associated with immune suppression. Internal Medicine Journal. 2011, 41: 715-721.