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Legionella pulmonary abscess and pleural space infection in an immunocompetent patient
  1. Kristen L Flint1,2,
  2. Maxwell R Lloyd1,2,
  3. Polly van den Berg1,2 and
  4. Zahir Kanjee1,2
  1. 1Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
  2. 2Harvard Medical School, Boston, MA, USA
  1. Correspondence to Dr Kristen L Flint; kflint{at}bidmc.harvard.edu

Abstract

A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her Legionella urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. CT imaging revealed interval development of a loculated complicated parapneumonic effusion. Successful treatment required chest tube drainage assisted by fibrinolytic therapy. This case highlights the importance of considering Legionella in patients with pulmonary abscess, demonstrates an approach to a patient with a non-resolving pneumonia and illustrates the management of parapneumonic effusions.

  • pneumonia (infectious disease)
  • pleural infection
  • pneumonia (respiratory medicine)

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Footnotes

  • KLF and MRL are joint first authors.

  • Twitter @vdbPolly, @zahirkanjee

  • Contributors KLF and MRL contributed equally to the conception and design of the work, drafting and critical revision of the article. As such, KLF and MRL share the role of joint first authors. PvdB and ZK contributed to the design of the work and critical revision of the article. All authors contributed to the final approval of the version to be published.

  • 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 ZK serves on a paid advisory board for Wolters Kluwer and receives royalties from Wolters Kluwer for medical books he edited. There are no competing interests for any other authors.

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