Atrio-Ventricular Block by Legionella Disease

Although Legionnaires' disease mainly affects the lungs, it can also present with other systemic involvement, including rare cardiac manifestations. Recognised presentations are endocarditis, myocarditis, pericarditis, and pericardial effusion. A 72-year-old British man presented with a six-day history of dry cough and a four-day history of fever during the peak of the COVID-19 pandemic. His electrocardiogram showed Mobitz type II atrio-ventricular block. Although all the cultures were negative, the chest X-ray demonstrated COVID-19 infection-like features. With high clinical suspicions and chest X-ray features, the polymerase chain reaction of the COVID tests was repeated three times and all were negative. He had a positive urinary Legionella antigen, and his bradycardia and heart block improved after treatment with amoxicillin/clavulanic acid, and clarithromycin. As the electrocardiogram showed Mobitz type II, a permanent pacemaker was implanted. The follow-up pacemaker check showed that he still required active pacing.