A49-18 Atypical Presentation of Legionella Pneumonia Masquerading as Hypovolemic Shock in a Hospitalized Patient
Abstract
Abstract Legionella pneumophila is a common cause of atypical pneumonia but can present with a broad spectrum of extrapulmonary and nonspecific symptoms, often delaying diagnosis and treatment. We report a case of Legionella pneumonia in a 62-year-old F admitted for acute exacerbation of chronic low back pain who subsequently developed hypotension and acute respiratory failure. On admission, she denied respiratory symptoms, and initial evaluation was unremarkable aside from discomfort. During hospitalization, she developed progressive hypotension unresponsive to intravenous fluids, requiring vasopressors and ICU transfer for presumed shock of unclear etiology. Shortly after, she experienced worsening dyspnea and hypoxia, necessitating intermittent noninvasive ventilation and high-flow nasal cannula. Computed tomography of the chest revealed bilateral ground glass opacities, bronchiectasis, and small pleural effusions, raising suspicion for atypical infection. Given her clinical course and lack of initial respiratory findings, Legionella infection was considered. A urinary antigen test returned positive for Legionella pneumophila. Empiric therapy with azithromycin and levofloxacin was initiated and rifampin was later added and azithromycin discontinued to enhance antimicrobial synergy due to disease severity. Diuresis with intravenous furosemide was also started to address concurrent volume overload. The patient demonstrated decline in hemodynamics and oxygenation despite…
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