[Severe Legionnaire's disease revealing an invasive aspergillosis in an apparently immunocompetent patient].
BACKGROUND
Invasive aspergillosis, a sever disease, usually occurs in immuno-depressed patients. However, it may also develop in presumably immuno-competent patients.


METHODS
A 54-year-old man, smoker, was hospitalised for hypoxemia of the right lung and septic shock, rapidly requiring mechanical ventilation combined with administration of vasopressors, and followed by dialysis because of the rapid worsening of an acute kidney failure. The diagnosis of pulmonary Legionnaire's disease was made on the second day in view of the positivity of the urinary legionella antigen. The progression of the disease was marked by the discovery of a histologically documented gastric aspergillosis and three abscessed intracerebral lesions within the context of a strongly positive aspergillus antigenemia. The disease worsened and the patient died on D 17, despite the antibiotic and anti-aspergillus treatments, haemodynamic support and dialysis.


CONCLUSIONS
To our knowledge, the association of invasive aspergillosis and severe Legionnaire's disease has never been described in an presumably immunocompetent patient. This clinical case suggests the existence, other than the usual risk factors of invasive aspergillosis that characterise profound states of immunodepression, of more subtle alterations in the immune system that may enhance this type of infection.
Vergne
S
S
Unité de réanimation et de soins intensifs cardiologiques, Centre hospitalier intercommunal du Val d'Ariège (Chiva), 09017 Foix Cedex.
Lathuile
D
D
Bénosa
B
B
Fragnier
F
F
Destrac
S
S
Avedan
M
M
Alzieu
M
M
Campistron
J
J
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D000900:Anti-Bacterial Agents; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D001232:Aspergillus fumigatus; D001921:Brain / Q000473:pathology; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D003131:Combined Modality Therapy; D003422:Critical Care; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007121:Immunocompetence / Q000276:immunology; D016952:Legionella pneumophila; D007877:Legionnaires' Disease / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008168:Lung / Q000473:pathology; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents