"A Rare Case of Legionella Necrotizing Pneumonia in Liver Cirrhosis" by Usman Bin Hameed, Mujtaba Moazzam et al.
 

A Rare Case of Legionella Necrotizing Pneumonia in Liver Cirrhosis

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

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 azithromycin to complete a total 14-day course. At follow-up, he reported significant clinical improvement, with minimal residual cough, and a follow-up CT showed a 61 x 29 mm reduction in the cavitary lesion, consistent with resolving necrotizing pneumonia. Cavitary or necrotic presentations of Legionella pneumophila are mostly documented in patients with profound immunosuppression (hematologic malignancies or high-dose corticosteroid use). Our patient’s case of cavitary Legionella pneumonia in the context of liver cirrhosis broadens the understanding of host factors influencing disease severity, as chronic liver disease may subtly impair immunity and increase susceptibility to atypical, severe infections. Treatment modalities for Legionella include macrolides (e.g., azithromycin), fluoroquinolones (e.g., levofloxacin), and in severe cases, adjunctive rifampin. In cases of slow response or complications like abscesses, prolonged antibiotic courses are essential. Surgical or radiologic drainage is considered when lesions are resistant to medical therapy alone. In this case, the patient received prolonged antibiotics with levofloxacin and azithromycin, achieving lesion resolution on follow-up imaging. This case underscores the need to consider atypical Legionella presentations in patients with chronic liver disease, emphasizing the importance of diagnostic diligence and tailored, often extended antimicrobial regimens when managing aggressive pulmonary pathology.

Volume

211

First Page

A6743

Comments

American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA

Last Page

A6743

DOI

10.1164/ajrccm.2025.211.Abstracts.A6743

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