A Survived Case of Fatal Legionella Pneumonia Caused by Legionella pneumophila Serogroup 6 and Legionella dumoffii Treated with Extracorporeal Lung Assist.

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A 75-year-old man who developed fatal Legionella pneumonia due to near drowning was transferred to our medical center because of severe hypoxia (P/F 46.8). His pulmonary oxygenation was gradually improved (P/F 482 on day 7) by mechanical ventilation, then his respiratory condition deteriorated rapidly (P/F 57.60 on day 10) with high-grade fever, leucocytosis, and increased CRP. Chest radiography showed severe interstitial and pulmonary infiltrates in almost all of the lung field. To avoid high-pressure mechanical ventilation and highly concentrated oxygen inspiration, V-V bypass extracorporeal lung assist (ECLA) was begun and bronchoalveolar lavage (BAL) was conducted on day 11. Legionella pneumophila serogroup 6 (LPSG6) was detected from BAL fluid and clarithromycin and rifampicin administered orally for 4 weeks. Serum antigen titer for LPSG6 and Legionella dumoffii was×512 on day 23. In his clinical course, ECLA was done twice (from day 10 to 23 and from day 37 to 47). He recovered and was discharged on day 116. Legionella pneumonia caused byLPSG6 and L. dumoffii is still rare. In Legionnaires' disease, these pathogens must be considered and serological and/or culture diagnosis made early in the clinical course.
一般社団法人日本救急医学会の論文