title: Lung abcess complicating Legionella micdadei pneumonia in an adult liver transplant recipient: case report and review.
abstract: Legionella micdadei (Pittsburgh pneumonia agent) is the second most common cause of Legionella pneumonia, and occurs predominantly in immunocompromised hosts. L micdadei is the cause of nosocomial pneumonia in renal transplant recipients, but has not been described in other adult solid organ transplant recipients. This report describes the first case of L micdadei pneumonia in an adult liver transplant recipient on immunosuppressive therapy. Importantly, this case highlights the difficulties in establishing the diagnosis, as the Legionella urinary antigen is negative, and special culture conditions are required. Furthermore, this case illustrates several atypical clinical features of L micdadei pneumonia in a transplant recipient, including a community acquired mode of transmission, occurrence several years after organ transplantation, and lung abcess formation. The patient was successfully treated with limited surgical resection and quinolone antimicrobial monotherapy.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02215, USA.
authors.forename: A
authors.initials: A
authors.lastname: Ernst
authors.forename: F D
authors.initials: FD
authors.lastname: Gordon
authors.forename: J
authors.initials: J
authors.lastname: Hayek
authors.forename: R C
authors.initials: RC
authors.lastname: Silvestri
authors.forename: H
authors.initials: H
authors.lastname: Koziel
mesh_terms: D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D002939:Ciprofloxacin / Q000627:therapeutic use; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007876:Legionellosis / Q000150:complications*; D016031:Liver Transplantation; D008169:Lung Abscess / Q000150:complications*; D008297:Male; D018410:Pneumonia, Bacterial / Q000150:complications*; D011183:Postoperative Complications; D016559:Tacrolimus / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
chemical_list: D000890:Anti-Infective Agents; D007166:Immunosuppressive Agents; D002939:Ciprofloxacin; D016559:Tacrolimus