C57-07 A Chill in the Air, a Fire in the Lungs: Legionella Pneumonia Case Report
Abstract
Legionella pneumophila is a significant yet underrecognized cause of severe community-acquired pneumonia (CAP), accounting for 1-9% of cases. Severe infection may lead to respiratory failure, multiorgan dysfunction, and high mortality, particularly when diagnosis or treatment is delayed. Environmental exposure through aerosolized contaminated water sources remains a key risk factor. We report a case of fulminant Legionella pneumonia with rapid progression to multiorgan failure and death, temporally associated with use of a portable air-conditioning unit.
A 54-year-old female with a history of epilepsy (not on antiepileptics), substance use disorder, bipolar disorder, type 2 diabetes, prior cerebrovascular accident, and an indeterminate renal mass was found unresponsive at home; last known well was two hours prior. She was febrile to 40.4 °C, tachycardic to 151 bpm, hypertensive at 150/108 mmHg, tachypneic at 44 breaths/min, and minimally responsive. She was intubated for airway protection due to seizure-like activity and inability to protect her airway.Arterial blood gas showed acute hypoxic hypercapnic respiratory failure (pH 7.17, pCO2 61 mmHg). Labs were notable for acute kidney injury (Cr 1.39 from baseline 0.5-0.8), lactic acidosis (4.5 mmol/L), thrombocytopenia (70 K/µL), elevated CK (7,018 U/L), and marked transaminitis (AST 1,232 U/L, ALT 421 U/L). Chest CT revealed dense bilateral lower lobe consolidations.Urinary Legionella antigen returned positive. Family…
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