SHM Converge Scientific Abstract ePoster Gallery-Legionella Pneumophila Serotype 1 Pneumonia in Man on Anti-TNF-Alpha Immunotherapy

Pdf Summary

A 43-year-old man with seropositive ankylosing spondylitis, tobacco use, and anti-TNF-α therapy with adalimumab developed severe Legionella pneumophila serotype 1 pneumonia complicated by acute encephalopathy. He presented with high fever, tachycardia, tachypnea, diffuse left-sided crackles, leukocytosis, hyponatremia, and acute kidney injury. Imaging showed left upper lobe dense mass-like consolidation, and both urine antigen testing and tracheal aspirate culture confirmed Legionella.<br /><br />He was initially treated with azithromycin, but did not improve and progressed to respiratory failure requiring intubation, septic shock, and dialysis-requiring kidney injury. After switching to levofloxacin, his fevers resolved and he improved rapidly.<br /><br />This case highlights anti-TNF-α immunotherapy as an important risk factor for severe Legionella infection, with reported relative risk estimates ranging from 16.5 to 21.0. It also emphasizes that macrolide monotherapy may be inadequate in severe cases, and fluoroquinolones may be a more effective option in immunocompromised patients.

Asset Subtitle

Luqman Croal-Abrahams

Meta Tag

Author List Folasade Arinze, Gayatri Menon, Luqman Croal-Abrahams

Category Clinical Vignettes

Concept Anti-TNF Therapy

Concept Legionella pneumophila

Concept Legionella Pneumonia

Concept Pneumonia

Concept Respiratory Failure

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Luqman Croal-Abrahams

Track Adult

Keywords

Legionella pneumophila

Legionella pneumonia

anti-TNF therapy

adalimumab

ankylosing spondylitis

immunocompromised

azithromycin failure

levofloxacin

acute encephalopathy

septic shock

Anti-TNF Therapy

Legionella pneumophila

Legionella Pneumonia

Pneumonia

Respiratory Failure