第３病日に診断を確定し，救命し得た重症レジオネラ肺炎の１例

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A 48-year-old man was admitted to our hospital after suffering from fever, dyspnea, and disturbance of gait for four days before admission. A chest X-ray taken in the emergency unit showed ground glass-like infiltrates in the left upper lung field and blood examinations demonstrated increases in serum CRP,CPK,and AST and a decrease in sodium.Bacterial pneumonia was diagnosed and the patient was started on intravenous administration of doripenem. On hospital day 2, a second chest X-ray revealed that the infiltration had worsened, causing exacerbation of his hypoxemia. We immediately shifted to a combination therapy of pazufloxacin,minomycin, and erythromycin since the Legionella species was suspected to be infecting bacterium. Legionella antigen present in urinalysis on day 3 confirmed this diagnosis. However, the patient’s respiratory condition had rapidly deteriorated, necessitating the use of a respirator. His condition gradually improved with the intensive treatment and he was discharged on hospital day 23. Prompt diagnosis and treatment is necessary for Legionella pneumonia since this disease is one of the main sources of communityacquired pneumonia causing severe symptoms despite of appropriate treatment. Thus, clinicians should bear Legionella pneumonia in mind when treating cases with suspected pneumonia who show the specific clinical findings of this disease,such as an increase in serum AST and a decrease in sodium
2011-02-10