Clinical Features of Two Cases of Legionnaires' Disease with Persistence of Legionella Urinary Antigen Excretion

Futoshi Higa, Jiro Fujita, Michio Koide, Shusaku Haranaga, Masao Tateyama
2008 Internal medicine (Tokyo. 1992)  
The advantages of diagnosing legionellosis by urinary antigen detection are widely recognized, and include early detection, rapidity of testing, and ease of specimen collection. However, the persistence of Legionella urinary antigen excretion has been suggested in some selected patients, although the clinical features of these patients have not yet been clearly described. Here, we describe the clinical features of two patients with Legionnaires' disease with persistence of Legionella urinary
more » ... igen excretion (117 days and 247 days). One patient had an underlying disease, adult T-cell leukemia, and the other patient had ulcerative colitis and was receiving oral corticosteroids. Unusual clinical and radiological findings as well as a review of the literature are presented. Case Reports Case 1 A 48-year-old woman was admitted to our hospital with high fever, chills, cough, exertional dyspnea and yellow jelly-like sputum that had persisted for five days prior to admission. On admission, the patient was alert but slightly excited and talkative. Body temperature was 38.4 , blood pressure 100/60 mmHg, pulse regular at 88 bpm, and a respiratory rate of 32 breaths/min. Superficial lymphadenopathy and mild splenomegaly were noted. Heart sounds were clear, mild coarse crackles were noted in both lower lung fields. Chest roentgenogram showed bilateral alveolar infiltration in the middle and lower lung fields (Fig. 1A) . Chest computed tomography (CT) scan showed right pleural effusion and alveolar infiltrates in both lung fields (Fig. 1B) . Bronchoscopic examination was performed on admission and approximately 6 ml of bronchial lavage fluid was obtained at right B9. Giemsa staining of the bronchial lavage fluid showed 30% neutrophils and 70% abnormal cells with
doi:10.2169/internalmedicine.47.0522 pmid:18239328 fatcat:khmtov3qbzbnng2hmxxwwgcclm