Hasegawa Juri, Horikawa Tomohumi, Endo Kazuhiro
Department of Neurology, Tomishiro Central Hospital.
Rinsho Shinkeigaku. 2013;53(7):526-30. doi: 10.5692/clinicalneurol.53.526.
A 60-year-old man was admitted to our hospital because of fever and mental status change. Neurological examination showed meningeal irritation and frontal sign. Cerebrospinal fluid (CSF) examination showed mild pleocytosis and elevated protein. Laboratory findings showed hyponatremia, elevated liver enzymes and creatine phosphokinase, and positive Legionella pneumophila antigen in urine. The chest computed tomographic scans showed consolidation in the left lower lobe lung. We diagnosed Legionnaires' pneumonia and started treatment with levofloxacin. Legionella pneumophila was isolated from culture of the bronchoalveolar lavage fluid, but Legionella culture and polymerase chain reaction in CSF were negative. We hypothesize that Legionella pneumophila could produce nerological symptoms by immune-mediated mechanism associated with elevated IgG index. The neurologist should recognize the presence of the meningo-encephalitis associated with Legionnaires' pneumonia lacking remarkable pulmonary symptoms.
一名60岁男性因发热和精神状态改变入住我院。神经系统检查显示有脑膜刺激征和额叶征。脑脊液（CSF）检查显示轻度细胞增多和蛋白升高。实验室检查结果显示低钠血症、肝酶和肌酸磷酸激酶升高，尿中嗜肺军团菌抗原阳性。胸部计算机断层扫描显示左下肺实变。我们诊断为军团菌肺炎并开始用左氧氟沙星治疗。支气管肺泡灌洗液培养分离出嗜肺军团菌，但脑脊液中的军团菌培养和聚合酶链反应均为阴性。我们推测嗜肺军团菌可能通过与IgG指数升高相关的免疫介导机制产生神经症状。神经科医生应认识到存在与军团菌肺炎相关的脑膜脑炎，而肺部症状不明显。
