A69-30 Severe Legionella Pneumonia Leading to ARDS in an Immunocompromised Host With Substance Use Disorder
Abstract
Community-acquired pneumonia (CAP) leads to roughly 650 hospitalizations per 100,000 adults annually in the U.S., whereas Legionella occurs at 1.4-1.8 cases per 100,000 worldwide. Legionella, transmitted via inhaled contaminated aerosols, poses heightened risk in those with immunosuppression, chronic lung disease, older age, or substance use, often causing severe, ICU-level illness1.
51-year-old female with cutaneous vasculitis and substance use disorder presented with three days of progressive left-sided abdominal pain, fever, nausea, vomiting, constipation, dark urine, productive cough and dyspnea. Social history was notable for five-pack-year smoking history and non-prescription opioid use, discontinued three days prior to presentation. A rapid response was activated for a National Early Warning Score of 5. She was febrile, tachypneic, and tachycardic, prompting ICU admission for acute hypoxemic respiratory failure requiring intubation. Empiric antibiotics with vancomycin, piperacillin-tazobactam, and azithromycin were initiated. Legionella urinary antigen returned positive, and Infectious Disease recommended adding rifampin. Therapy was narrowed to moxifloxacin. Patient developed severe Acute Respiratory Distress Syndrome (ARDS) secondary to Legionella pneumonia, requiring deep sedation, neuromuscular blockade, and proning for refractory hypoxemia, with a nadir P/F ratio of 116. Adjunctive care included ventilation adjustments, electrolyte repletion for an single episode…
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