title: Persistently positive culture results in a patient with community-acquired pneumonia due to Legionella pneumophila.
abstract: We describe a patient with community-acquired pneumonia due to Legionella pneumophila serogroup 6. This patient was found to have bronchoalveolar carcinoma of the lung by means of cytologic testing in 1 of 2 bronchoalveolar lavage samples, but no lesions were visible on bronchoscopy. Despite intravenous administration of azithromycin to the patient, repeat culture and polymerase chain reaction showed persistence of Legionella; the isolates remained susceptible to azithromycin. The patient did not respond to 14 doses of daily intravenously administered azithromycin. The poor outcome may have been partially due to the suspected underlying lung malignancy, as shown by cytologic examination, and by a delay in seeking medical attention.
authors.affiliation: Summa Health System and Northeastern Ohio Universities College of Medicine, Akron, OH 44304, USA. tanj@summa-health.org
authors.forename: J S
authors.initials: JS
authors.lastname: Tan
authors.forename: T M
authors.initials: TM
authors.lastname: File
authors.forename: J R
authors.initials: JR
authors.lastname: DiPersio
authors.forename: L P
authors.initials: LP
authors.lastname: DiPersio
authors.forename: R
authors.initials: R
authors.lastname: Hamor
authors.forename: L D
authors.initials: LD
authors.lastname: Saravolatz
authors.forename: J E
authors.initials: JE
authors.lastname: Stout
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016952:Legionella pneumophila / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D008826:Microbial Sensitivity Tests; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology / Q000503:physiopathology; D011859:Radiography; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D017963:Azithromycin