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Open Access Highly Accessed Case report

Legionella pneumophila infection presenting as headache, confusion and dysarthria in a human immunodeficiency virus-1 (HIV-1) positive patient: case report

Nathaniel M Robbins1*, Aditi Kumar2 and Barbra M Blair23

Author Affiliations

1 Department of Neurology, University of California, 505 Parnassus Ave. M-798, San Francisco, CA, 94137, USA

2 Department of Medicine, Mount Auburn Hospital, 330 Mount Auburn St., Cambridge, MA, 02138, USA

3 Harvard Medical School, Boston, MA, USA

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BMC Infectious Diseases 2012, 12:225  doi:10.1186/1471-2334-12-225

Published: 22 September 2012

Abstract

Background

Legionella pneumophila is a common cause of community-acquired pneumonia. Central nervous system dysfunction is common, and diagnosis in the absence of pulmonary symptoms can be challenging. Here we describe an atypical clinical presentation of Legionella infection in a patient with HIV who was found to have an unusual neuroradiologic lesion that further served to obscure the diagnosis. This is the first such description in a patient with Legionellosis and HIV coinfection.

Case presentation

A 43 year-old HIV positive man presented to our hospital with dysarthria, fevers, headache, and altered mental status. Initial work-up revealed pneumonia and a lesion of the splenium of the corpus callosum on magnetic resonance imaging. He was subsequently diagnosed with Legionella pneumonia and treated with complete symptom resolution.

Conclusions

Neurologic abnormalities are frequent in Legionellosis, but the diagnosis may be difficult in the absence of overt respiratory symptoms and in the presence of HIV coinfection. A high index of suspicion and early initiation of empiric antibiotics is imperative since early treatment may help prevent long-term sequelae. Neuroimaging abnormalities, though rare, can help the physician narrow down the diagnosis and avoid unnecessary invasive testing. Future studies should aim to elucidate the as yet unknown role of neuroimaging in the diagnoses and prognostication of Legionellosis, as well as the interaction between Legionella infection and HIV.

Keywords:
Legionella; Legionellosis; Splenium; Corpus callosum; MRI; HIV; Encephalopathy