title: First reported United States case of Legionella pneumophila serogroup 1 pneumonia in a patient receiving anti-tumor necrosis factor-alpha therapy.
abstract: Legionellosis has been reported to be an extremely rare disease in Hawai'i. The authors report a case of a 67-year-old woman with a history of rheumatoid arthritis treated with long-term adalimumab who developed severe right-sided community-acquired pneumonia and a parapneumonic effusion. Legionella pneumophila serogroup 1 was confirmed as the microbiologic cause based on a positive urine Legionella antigen as well as direct fluorescent antibody and Legionella culture of bronchoalveolar lavage. This is the first reported case of Legionella pneumonia associated with anti-tumor necrosis factor (TNF)-alpha therapy in the United States. There have been several reports of an increased association between legionellosis and treatment with a TNF-alpha antagonist. With the increasing use of TNF-alpha antagonists, Legionella pneumophila should be recognized as a potential re-emerging pathogen. Clinicians should particularly consider the diagnosis of legionellosis in patients who are immunocompromised, including those who receive anti-TNF-alpha therapy, or who have severe pneumonia. In such cases, there should be a low threshold for including empiric Legionella antimicrobial coverage until the diagnosis can be confirmed or reasonably excluded.
authors: University Hospitals of Cleveland Case Medical Center, Cleveland, OH 44118, USA. sadaoj@gmail.com
authors: Sadao
authors: S
authors: Jinno
authors: Stephen
authors: S
authors: Pulido
authors: Brian C
authors: BC
authors: Pien
mesh_terms: D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000276:immunology; D044466:Asian People; D005260:Female; D006254:Hawaii; D006801:Humans; D016867:Immunocompromised Host; D016952:Legionella pneumophila / Q000145:classification / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000276:immunology / Q000382:microbiology*; D012703:Serotyping; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab