Publication: Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: Case report and literature review
Issued Date
2018-09-17
Resource Type
ISSN
14712334
Other identifier(s)
2-s2.0-85053407652
Rights
Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC Infectious Diseases. Vol.18, No.1 (2018)
Suggested Citation
Maria N. Chitasombat, Natta Ratchatanawin, Yingluck Visessiri Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: Case report and literature review. BMC Infectious Diseases. Vol.18, No.1 (2018). doi:10.1186/s12879-018-3378-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/46321
Research Projects
Organizational Units
Authors
Journal Issue
Thesis
Title
Disseminated extrapulmonary Legionella pneumophila infection presenting with panniculitis: Case report and literature review
Other Contributor(s)
Abstract
© 2018 The Author(s). Background: Legionellosis is a well-known cause of pneumonia. Primary cutaneous and subcutaneous infection caused by Legionella pneumophila is rare and the diagnosis is challenging. Case presentation: A 38-year-old Thai woman with systemic lupus erythematosus and myasthenia gravis treated with prednisolone and azathioprine presented to our hospital with low-grade fever, diarrhea, and indurated skin lesions on both thighs. Initial examination showed plaques on both inner thighs. Magnetic resonance imaging showed myositis and swelling of the skin and subcutaneous tissue. Diagnosis of panniculitis due to L. pneumophila was carried out by histopathology, Gram stain, and 16S rRNA gene sequencing method of tissue biopsy from multiple sites on both thighs. Myocarditis was diagnosed by echocardiography. The final diagnosis was disseminated extrapulmonary legionellosis. Treatment comprised intravenous azithromycin for 3 weeks and the skin lesions, myositis and myocarditis resolved. Oral azithromycin and ciprofloxacin were continued for 3 months to ensure eradication of the organism. The patient's overall condition improved. Conclusions: To our knowledge, we report the first case of L. pneumophila infection manifesting with panniculitis, possible myositis, and myocarditis in the absence of pneumonia. The diagnosis of extrapulmonary Legionella infection is difficult, especially in the absence of pneumonia. A high index of suspicion and appropriate culture with special media or molecular testing are required. Initiation of appropriate treatment is critical because delaying therapy was associated with progressive infection in our patient.