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Published in: BMC Infectious Diseases 1/2021

Open Access 01-12-2021 | Pneumonia | Case report

Legionnaire’s disease presenting as bilateral central scotomata: a case report

Authors: Sho Yamada, Takamasa Kitajima, Satoshi Marumo, Motonari Fukui

Published in: BMC Infectious Diseases | Issue 1/2021

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Abstract

Background

Legionnaire’s disease is one of the major causes of community-acquired pneumonia and is occasionally complicated by neurological symptoms. However, reports of ocular lesions due to Legionnaire’s disease are limited.

Case presentation

We report the case of a patient with Legionnaire’s disease presenting as bilateral central scotomata due to retinal lesions. The patient consulted due to fever and bilateral central scotomata, as well as other extrapulmonary symptoms. Optical coherence tomography (OCT) showed bilateral accumulations of fluid under the retina, and the patient was diagnosed with bilateral exudative retinal detachment. Later, Legionnaire’s disease was confirmed by pulmonary infiltrates on chest imaging and positive urinary antigen for Legionella pneumophila. After administration of antibiotics, the bilateral central scotomata and bilateral subretinal fluid accumulations completely resolved, as did the other extrapulmonary symptoms and the pulmonary infiltrates. Thus, the bilateral central scotomata due to exudative retinal detachment were thought to be caused by Legionnaire’s disease.

Conclusions

This case demonstrates that Legionnaire’s disease can present as bilateral central scotomata. We may consider the possibility of extrapulmonary involvement complicating Legionnaire’s disease when we encounter bilateral ocular lesions in patients with fever and pneumonia.
Literature
1.
go back to reference Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373:415–27.CrossRef Jain S, Self WH, Wunderink RG, Fakhran S, Balk R, Bramley AM, et al. Community-acquired pneumonia requiring hospitalization among US adults. N Engl J Med. 2015;373:415–27.CrossRef
2.
go back to reference Viasus D, Di Yacovo S, Garcia-Vidal C, Verdaguer R, Manresa F, Dorca J, et al. Community-acquired Legionella pneumophila pneumonia: a single-center experience with 214 hospitalized sporadic cases over 15 years. Medicine (Baltimore). 2013;92:51–60.CrossRef Viasus D, Di Yacovo S, Garcia-Vidal C, Verdaguer R, Manresa F, Dorca J, et al. Community-acquired Legionella pneumophila pneumonia: a single-center experience with 214 hospitalized sporadic cases over 15 years. Medicine (Baltimore). 2013;92:51–60.CrossRef
3.
go back to reference Cunha BA, Cunha CB. Legionnaire’s disease: a clinical diagnostic approach. Infect Dis Clin. 2017;31:81–93.CrossRef Cunha BA, Cunha CB. Legionnaire’s disease: a clinical diagnostic approach. Infect Dis Clin. 2017;31:81–93.CrossRef
4.
go back to reference Halperin JJ. Nervous system abnormalities and Legionnaire’s disease. Infect Dis Clin. 2017;31:55–68.CrossRef Halperin JJ. Nervous system abnormalities and Legionnaire’s disease. Infect Dis Clin. 2017;31:55–68.CrossRef
5.
go back to reference Friedland L, Snydman DR, Weingarden AS, Hedges TR, Brown R, Busky M. Ocular and pericardial involvement in legionnaires’ disease. Am J Med. 1984;77:1105–7.CrossRef Friedland L, Snydman DR, Weingarden AS, Hedges TR, Brown R, Busky M. Ocular and pericardial involvement in legionnaires’ disease. Am J Med. 1984;77:1105–7.CrossRef
6.
go back to reference Heriot WJ, Mack HG, Stawell R. Ocular involvement in a patient with Legionella longbeachae 1 infection. Clin Exp Ophthalmol. 2014;5:497–9.CrossRef Heriot WJ, Mack HG, Stawell R. Ocular involvement in a patient with Legionella longbeachae 1 infection. Clin Exp Ophthalmol. 2014;5:497–9.CrossRef
7.
go back to reference Fernández-Sabé N, Rosón B, Carratalà J, Dorca J, Manresa F, Gudiol F. Clinical diagnosis of Legionella pneumonia revisited: evaluation of the community-based pneumonia incidence study group scoring system. Clin Infect Dis. 2003;37:483–9.CrossRef Fernández-Sabé N, Rosón B, Carratalà J, Dorca J, Manresa F, Gudiol F. Clinical diagnosis of Legionella pneumonia revisited: evaluation of the community-based pneumonia incidence study group scoring system. Clin Infect Dis. 2003;37:483–9.CrossRef
8.
go back to reference Cunha BA. Severe Legionella pneumonia: rapid presumptive clinical diagnosis with Winthrop-University Hospital’s weighted point score system (modified). Heart Lung. 2008;37:311–20.CrossRef Cunha BA. Severe Legionella pneumonia: rapid presumptive clinical diagnosis with Winthrop-University Hospital’s weighted point score system (modified). Heart Lung. 2008;37:311–20.CrossRef
9.
go back to reference Fiumefreddo R, Zaborsky R, Haeuptle J, Christ-Crain M, Trampuz A, Steffen I, et al. Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department. BMC Pulm Med. 2009;9:4.CrossRef Fiumefreddo R, Zaborsky R, Haeuptle J, Christ-Crain M, Trampuz A, Steffen I, et al. Clinical predictors for Legionella in patients presenting with community-acquired pneumonia to the emergency department. BMC Pulm Med. 2009;9:4.CrossRef
10.
go back to reference Haubitz S, Hitz F, Graedel L, Batschwaroff M, Wiemken TL, Peyrani P, et al. Ruling out Legionella in community-acquired pneumonia. Am J Med. 2014;127:1010.e11–9.CrossRef Haubitz S, Hitz F, Graedel L, Batschwaroff M, Wiemken TL, Peyrani P, et al. Ruling out Legionella in community-acquired pneumonia. Am J Med. 2014;127:1010.e11–9.CrossRef
11.
go back to reference Newman N, Biousse V. Diagnostic approach to vision loss. Continuum. 2014;20:785–815.PubMed Newman N, Biousse V. Diagnostic approach to vision loss. Continuum. 2014;20:785–815.PubMed
12.
go back to reference Huff JS, Austin EW. Neuro-ophthalmology in emergency medicine. Emerg Med Clin. 2016;34:967–86.CrossRef Huff JS, Austin EW. Neuro-ophthalmology in emergency medicine. Emerg Med Clin. 2016;34:967–86.CrossRef
13.
go back to reference Amer R, Nalcı H, Yalçındağ N. Exudative retinal detachment. Surv Ophthalmol. 2017;62:723–69.CrossRef Amer R, Nalcı H, Yalçındağ N. Exudative retinal detachment. Surv Ophthalmol. 2017;62:723–69.CrossRef
14.
go back to reference Shah DN, Al-Moujahed A, Newcomb CW, Kaçmaz RO, Daniel E, Thorne JE, et al. Exudative retinal detachment in ocular inflammatory diseases: risk and predictive factors. Am J Ophthalmol. 2020;218:279–87.CrossRef Shah DN, Al-Moujahed A, Newcomb CW, Kaçmaz RO, Daniel E, Thorne JE, et al. Exudative retinal detachment in ocular inflammatory diseases: risk and predictive factors. Am J Ophthalmol. 2020;218:279–87.CrossRef
15.
go back to reference Wolfensberger TJ, Tufail A. Systemic disorders associated with detachment of the neurosensory retina and retinal pigment epithelium. Curr Opin Ophthalmol. 2000;11:455–61.CrossRef Wolfensberger TJ, Tufail A. Systemic disorders associated with detachment of the neurosensory retina and retinal pigment epithelium. Curr Opin Ophthalmol. 2000;11:455–61.CrossRef
16.
go back to reference Nishitarumizu K, Tokuda Y, Uehara H, Taira M, Taira K. Tubulointerstitial nephritis associated with legionnaires’ disease. Intern Med. 2000;39:150–3.CrossRef Nishitarumizu K, Tokuda Y, Uehara H, Taira M, Taira K. Tubulointerstitial nephritis associated with legionnaires’ disease. Intern Med. 2000;39:150–3.CrossRef
17.
go back to reference Shah A, Check F, Baskin S, Reyman T, Menard R. Legionnaires’ disease and acute renal failure: case report and review. Clin Infect Dis. 1992;14:204–7.CrossRef Shah A, Check F, Baskin S, Reyman T, Menard R. Legionnaires’ disease and acute renal failure: case report and review. Clin Infect Dis. 1992;14:204–7.CrossRef
Metadata
Title
Legionnaire’s disease presenting as bilateral central scotomata: a case report
Authors
Sho Yamada
Takamasa Kitajima
Satoshi Marumo
Motonari Fukui
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2021
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-020-05715-y

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