title: Cutaneous legionellosis: case report and review of the medical literature.
abstract: Discrete nodules developed on the leg of a 27-year-old immunosuppressed woman after an allogeneic stem cell transplant. Biopsy and culture grew Legionella pneumophila serogroup 8. On day 7 of azithromycin treatment, respiratory distress and abnormal liver transaminases developed, and the patient died on day 14. Review of the medical literature identified 19 reports of Legionella species-associated skin or soft tissue infections (total of 20 patients, 13 with confirmed infection). Manifestations of the 13 confirmed cases included erythematous macular rash (n = 7), erythema after thoracentesis (n = 1), abscess formation (n = 4), respiratory symptoms (n = 6), and abnormal chest radiographs (n = 8). Six required surgical exploration and débridement, and 7 were immunocompromised. Rash and respiratory infection improved with antibiotics in 10, but 3 died. Immunosuppression may predispose transplant recipients to Legionella infections. Diagnostic biopsies may facilitate appropriate treatment.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Padrnos
authors.forename: J E
authors.initials: JE
authors.lastname: Blair
authors.forename: S
authors.initials: S
authors.lastname: Kusne
authors.forename: D J
authors.initials: DJ
authors.lastname: DiCaudo
authors.forename: J R
authors.initials: JR
authors.lastname: Mikhael
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D016952:Legionella pneumophila; D007877:Legionnaires' Disease / Q000150:complications*; D017192:Skin Diseases, Bacterial / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D033581:Stem Cell Transplantation
keywords: Legionella; Legionella pneumophila; cutaneous infection; legionellosis