Padrnos L J, Blair J E, Kusne S, DiCaudo D J, Mikhael J R
Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
Transpl Infect Dis. 2014 Apr;16(2):307-14. doi: 10.1111/tid.12201. Epub 2014 Mar 17.
Discrete nodules developed on the leg of a 27-year-old immunosuppressed woman after an allogeneic stem cell transplant. Biopsy and culture grew Legionella pneumophila serogroup 8. On day 7 of azithromycin treatment, respiratory distress and abnormal liver transaminases developed, and the patient died on day 14. Review of the medical literature identified 19 reports of Legionella species-associated skin or soft tissue infections (total of 20 patients, 13 with confirmed infection). Manifestations of the 13 confirmed cases included erythematous macular rash (n = 7), erythema after thoracentesis (n = 1), abscess formation (n = 4), respiratory symptoms (n = 6), and abnormal chest radiographs (n = 8). Six required surgical exploration and débridement, and 7 were immunocompromised. Rash and respiratory infection improved with antibiotics in 10, but 3 died. Immunosuppression may predispose transplant recipients to Legionella infections. Diagnostic biopsies may facilitate appropriate treatment.
一名27岁接受同种异体干细胞移植的免疫抑制女性腿部出现离散结节。活检和培养培养出嗜肺军团菌血清型8。在阿奇霉素治疗的第7天，患者出现呼吸窘迫和肝转氨酶异常，并于第14天死亡。医学文献回顾发现19例军团菌属相关皮肤或软组织感染报告（共20例患者，13例确诊感染）。13例确诊病例的表现包括红斑性斑疹（n = 7）、胸腔穿刺后红斑（n = 1）、脓肿形成（n = 4）、呼吸道症状（n = 6）和胸部X光片异常（n = 8）。6例需要手术探查和清创，7例免疫功能低下。10例患者的皮疹和呼吸道感染经抗生素治疗后改善，但3例死亡。免疫抑制可能使移植受者易患军团菌感染。诊断性活检可能有助于进行适当治疗。
