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Case report
Cerebellar ataxia a unique initial presentation of Legionnaires’ disease
  1. Zaid Kaloti,
  2. Kendall Bell,
  3. Mowyad Khalid and
  4. Diane Levine
  1. Internal Medicine, Wayne State University, Detroit, Michigan, USA
  1. Correspondence to Dr Zaid Kaloti; zkaloti{at}med.wayne.edu

Abstract

We present a case of Legionnaires’ disease complicated by cerebellar ataxia. A 60-year-old man was diagnosed with Legionnaires’ disease by urine antigen after presenting to the hospital with a main problem of headache and gait instability. He also had a productive cough, as well as nausea, vomiting and diarrhoea. Initial physical examination revealed a positive Romberg test, positive pronator drift, severely unsteady gait and bilateral upper extremity resting tremors with the remainder of cranial nerves and neurological examination being unremarkable. The patient had a prolonged hospital course requiring endotracheal intubation and mechanical ventilation. He received 14 days of levofloxacin with resolution of the pneumonia. On repeat assessment prior to discharge, the patient’s neurological symptoms improved; however, he still had mild residual gait instability, dysdiadokinesia and difficulty with fine motor tasks such as writing. Romberg test remained positive.

  • pneumonia (infectious disease)
  • infectious diseases
  • neurology
  • brain stem / cerebellum
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Footnotes

  • Contributors ZK (primary author) was part of the primary team that admitted this patient. KB (second author) was responsible for completing a literature review pertaining to this topic, obtaining consent from the patient and drafting and editing the case report. KB was also part of the primary team that admitted this patient. KB was responsible for planning the project, finding supporting literature. MK (third author) was part of the consulting infectious disease team. MK was responsible for reviewing and editing the drafted report. DL (senior author) is Internal Medicine attending. DL was responsible for reviewing and editing the drafted report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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