Legionella: Organizing Pneumonia vs Persistent Infection

Organizing pneumonia is a rare subtype of interstitial lung disease that can occur following infectious alveolar insults. Imaging often demonstrates bilateral patchy opacification while biopsy reveals irregular alveolar fibrosis. Steroids are the treatment of choice, resulting in rapid clinical improvement. In this report, we describe a 69-year-old woman with a recent hospitalization for Legionella pneumonia who presented with worsening dyspnea and radiographic evidence of bilateral patchy infiltrates. Differential diagnoses included Legionella treatment failure and organizing pneumonia, therefore she was managed with both antibiotics and steroids. Her clinical status improved significantly the day after treatment initiation, making organizing pneumonia as the likely culprit for her initial decompensation. In patients with a recent history of lung injury who present with acute hypoxic respiratory failure, one must have a high index of suspicion for organizing pneumonia, for prompt treatment often results in rapid recovery.