Abstract
BackgroundLegionella pneumophila is a common cause of community-acquired pneumonia. Central nervous system dysfunction is common, and diagnosis in the absence of pulmonary symptoms can be challenging. Here we describe an atypical clinical presentation of Legionella infection in a patient with HIV who was found to have an unusual neuroradiologic lesion that further served to obscure the diagnosis. This is the first such description in a patient with Legionellosis and HIV coinfection.Case presentationA 43 year-old HIV positive man presented to our hospital with dysarthria, fevers, headache, and altered mental status. Initial work-up revealed pneumonia and a lesion of the splenium of the corpus callosum on magnetic resonance imaging. He was subsequently diagnosed with Legionella pneumonia and treated with complete symptom resolution.ConclusionsNeurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of HIV coinfection. A high index of suspicion and early initiation of empiric antibiotics is imperative since early treatment may help prevent long-term sequelae. Neuroimaging abnormalities, though rare, can help the physician narrow down the diagnosis and avoid unnecessary invasive testing. Future studies should aim to elucidate the as yet unknown role of neuroimaging in the diagnoses and prognostication of Legionellosis, as well as the interaction between Legionella infection and HIV.
Highlights
Legionella pneumophila is a common cause of community-acquired pneumonia
Neurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of Human immunodefiency virus (HIV) coinfection
In the case study reported below, we describe the challenge of diagnosing Legionella in a patient with HIV who presented with neurologic deficits and a hyperintense lesion of the splenium of the corpus callosum (SCC) on magnetic resonance imaging (MRI)
Summary
We describe an unusual case of Legionella pneumonia in a patient with HIV infection who presented with altered mental status, dysarthria, and neuroimaging abnormalities that cleared with clinical improvement. In this case, appropriate antibiotic therapy was started immediately upon presentation, even though the diagnosis of Legionellosis was not made until urinary antigens came back four days later. The patient did make a complete recovery, and we presume early antibiotic therapy helped in this convalescence to some extent This patient underwent brain MRI because he presented acutely ill with confusion and dysarthria in the setting of HIV infection without an obvious diagnosis. M-798, San Francisco, CA 94137, USA. 2Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn St., Cambridge, MA 02138, USA. 3Harvard Medical School, Boston, MA, USA
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