Cunha Burke A, Pherez Francisco Miled, Nouri Yelda
Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.
Heart Lung. 2008 May-Jun;37(3):238-41. doi: 10.1016/j.hrtlng.2007.10.003.
Legionnaires' disease is a common cause of non-zoonotic atypical community-acquired pneumonia (CAP). Legionnaires' disease has varied manifestations but may be diagnosed clinically on the basis of its characteristic pattern of extra-organ involvement. In a patient with non-zoonotic CAP, the clinical and laboratory features in a patient with CAP pointing to the diagnosis of Legionnaires' disease include relative bradycardia, mental confusion/ encephalopathy, loose stools/diarrhea, abdominal pain, mild/transient increases in serum transaminases, decreased serum phosphorous, a highly elevated C-reactive protein (CRP), elevated creatinine phosphokinase (CPK), highly elevated serum ferritin levels, or microscopic hematuria. The radiologic manifestations of Legionnaires' disease are varied and no radiographic appearance is pathopneumonic. Patchy infiltrates in Legionnaires' disease are symmetrical and rapidly progressive even on appropriate anti-Legionella antimicrobial therapy. Spontaneous unilateral pneumothorax is a rare radiographic manifestation of Legionnaires' disease. We present a case of a young male who is presenting clinical finding was that of spontaneous bilateral pneumothoraces due to Legionella CAP. We believe this is the first reported case of Legionnaires' disease presenting as spontaneous bilateral pneumothoraces. Clinicians should be aware of the protean radiological manifestations of Legionnaires' disease. In patients presenting with CAP and unilateral or bilateral spontaneous pneumothorax, clinicians should have Legionnaires' disease in the differential diagnosis.
军团病是社区获得性非人畜共患非典型肺炎(CAP)的常见病因。军团病有多种表现形式,但可根据其特征性的器官外受累模式进行临床诊断。在非人畜共患CAP患者中,提示军团病诊断的CAP患者的临床和实验室特征包括相对心动过缓、精神错乱/脑病、稀便/腹泻、腹痛、血清转氨酶轻度/短暂升高、血清磷降低、C反应蛋白(CRP)高度升高、肌酸磷酸激酶(CPK)升高、血清铁蛋白水平高度升高或镜下血尿。军团病的影像学表现多样,没有哪种影像学表现具有病理诊断意义。军团病的斑片状浸润是对称的,即使在接受适当的抗军团菌抗菌治疗时也会迅速进展。自发性单侧气胸是军团病罕见的影像学表现。我们报告一例年轻男性病例,其临床发现为军团菌CAP导致的自发性双侧气胸。我们认为这是首例报告的以自发性双侧气胸为表现的军团病病例。临床医生应了解军团病多样的影像学表现。对于出现CAP和单侧或双侧自发性气胸的患者,临床医生在鉴别诊断时应考虑到军团病。