A Rare Case of Legionella Necrotizing Pneumonia in Liver Cirrhosis
Abstract
Abstract Necrotizing pneumonia caused by Legionella pneumophila is exceptionally rare and typically seen in severely immunosuppressed individuals, such as those with HIV or undergoing organ transplantation. We report a rare case of necrotizing pneumonia due to Legionella pneumophila in a patient with alcoholic liver cirrhosis. This patient's liver disease introduced unique complexity, as chronic liver disease may subtly impair immune function, potentially increasing susceptibility to severe infections. A 44-year-old man with a history of alcoholic liver cirrhosis presented with abdominal pain, fever, and occasional non-productive cough, denying any recent travel, incarceration, or known TB exposure. His medical history included cirrhosis complicated by recurrent ascites, SBP, and coagulopathy. A chest CT revealed a 7 x 5 x 8 cm cavitary lesion in the left upper lobe with internal gas bubbles and air-fluid levels, suggestive of a necrotic infectious process. He was subsequently started on linezolid and piperacillin-tazobactam; however, linezolid was discontinued due to thrombocytopenia, and vancomycin was added.During this hospitalization, bronchoscopy with BAL identified Legionella pneumophila by PCR, leading to the initiation of levofloxacin. Blood, pleural fluid, and BAL cultures for fungi, TB, and other bacterial pathogens were negative.After a 14-day inpatient course of vancomycin, piperacillin-tazobactam, and levofloxacin, the patient was discharged on Augmentin and…
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