Severe Legionnaires' disease successfully treated using a combination of fluoroquinolone, erythromycin, corticosteroid, and sivelestat.
The patient was a 67-year-old man with diabetes mellitus who had been to a hot spring spa a few days before his admission. The diagnosis of Legionella pneumonia was made using a urinary antigen assay. Intravenous pazufloxacin and oral clarithromycin were started. However, despite these treatments, he developed acute respiratory distress syndrome (ARDS). He was administered the combination of intravenous pazufloxacin and erythromycin, corticosteroid, and sivelestat for two weeks. Then he was successfully recovered. The outcome suggests that treatment with corticosteroid and sivelestat, in addition to a combination of appropriate anti-Legionella antibiotics, should be considered for patients with severe Legionella pneumonia with ARDS.
Kakeya
Hiroshi
H
Division of Respiratory Diseases, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Isahaya. kakeya@nagasaki-u.ac.jp
Ehara
Naomi
N
Fukushima
Kiyoyasu
K
Seki
Masafumi
M
Izumikawa
Koichi
K
Yamamoto
Yoshihiro
Y
Yanagihara
Katsunori
K
Saito
Atsushi
A
Kohno
Shigeru
S
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004917:Erythromycin / Q000627:therapeutic use*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D005998:Glycine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D007877:Legionnaires' Disease / Q000150:complications / Q000188:drug therapy*; D008297:Male; D012128:Respiratory Distress Syndrome / Q000209:etiology; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; D004917:Erythromycin; C069195:sivelestat; D005998:Glycine