title: Severe Legionnaires' disease successfully treated using a combination of fluoroquinolone, erythromycin, corticosteroid, and sivelestat.
abstract: 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.
authors.affiliation: Division of Respiratory Diseases, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Isahaya. kakeya@nagasaki-u.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kakeya
authors.forename: Naomi
authors.initials: N
authors.lastname: Ehara
authors.forename: Kiyoyasu
authors.initials: K
authors.lastname: Fukushima
authors.forename: Masafumi
authors.initials: M
authors.lastname: Seki
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Saito
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015842:Serine Proteinase Inhibitors; D013449:Sulfonamides; D004917:Erythromycin; C069195:sivelestat; D005998:Glycine