Cavitary Legionella Pneumonia in AIDS: When Intracellular Immunity Failure Leads to Rapid Intrapulmonary Cavitation

Abstract

Introduction. Legionella is a frequent cause of bacterial pneumonia in patients with AIDS. While multiple organisms have been associated with cavitary pneumonia in this population, Legionella has not. Clinical Case. A middle-aged woman with HIV-AIDS and severely depressed CD-4 count presented with one month of progressively worsening productive cough and dyspnea. Serial imaging showed focal consolidations which multiplied and cavitated over the subsequent days. Legionella urine antigen was positive, and appropriate treatment was continued for 3 weeks total. The patient recovered quickly, and follow-up imaging 8 weeks later showed near-resolution of all lesions. Discussion. Cavitary pneumonia secondary to Legionella has been seldom described, traditionally in the context of immunosuppressive therapy. Patients with AIDS and severely depressed CD4 counts have significantly compromised cell-mediated immunity. This case highlights the importance of consideration for legionellosis in rapidly progressing cavitary pneumonia, especially in patients with severely compromised cell-mediated immunity, including those with HIV-AIDS.

Inflammatory Patterns Associated with Legionella in HIV and Pneumonia Coinfections

“…Recent studies also highlight a propensity for Legionella infections to occur in people living with HIV [ 19 , 20 ]. Moreover, immunosuppressed HIV-infected individuals have been shown to present with a more severe course of disease, resulting in higher mortality rates [ 20 , 21 ]. Despite these findings, there is a notable lack of studies investigating the role that Legionella infections play in the causation and consequences of pneumonia among people living with HIV.…”