Critical Role of Multiplex PCR in Diagnosing Legionella–SARS-CoV-2 Co-infection in a Severely Immunosuppressed Pregnant Patient: A Case Report
Abstract
Background: The pregnancy period is characterized by significant immunological shifts, creating a window of vulnerability to severe infections. This susceptibility is profoundly amplified in patients with iatrogenic immunosuppression, such as those receiving biologic therapy for inflammatory bowel disease. Sepsis in these patients presents important diagnostic and therapeutic challenges, as both common pathogens and atypical co-infections must be considered. Co-infection with Legionella pneumophila, a potent intracellular bacterium, and SARS-CoV-2, a virus known for inducing immune dysregulation, is exceptionally rare and can precipitate a life-threatening hyperinflammatory state.
The Case: We present a case of severe septic shock and acute respiratory failure resulting from this unusual dual infection in a uniquely compromised host. A 31-year-old female, 35 weeks pregnant, presented in ER with fever, dyspnea and altered general state, rapidly progressing to septic shock despite the broad spectrum antibiotic therapy initiated at admission. Her medical history was significant for ulcerative colitis treated with biologic therapy (Adalimumab) for the past two years. The investigations revealed septic shock, respiratory failure due to severe pneumonia. The obstetrical risk assessment conducted to emergency C section delivery due to high risk of complications and even death for both mother and child. A healthy premature baby was admitted to neonatal unit and the next day, the…
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