Legionnaires' disease on azithromycin leading to lofty liver levels

Legionnaires' disease is a serious, life-threatening pneumonia caused by the bacterium Legionella pneumophila. Legionella is a gram-negative bacillus transmitted via inhalation of water droplets, usually from air conditioners or hot tubs. Unlike many respiratory pathogens, Legionella does not spread from person to person. This bacterium primarily affects the pulmonary system, causing atypical community-acquired pneumonia often associated with gastrointestinal symptoms such as diarrhea. In rare cases, Legionella can involve the liver, leading to acute hepatitis. Fluoroquinolones and macrolides are the most effective and commonly used antibiotics for treating Legionnaires' disease. However, both antibiotic classes carry a potential risk of hepatotoxicity, which can result in elevated liver enzymes. Additionally, Legionella-induced liver injury may increase susceptibility to DILI. Here, we present a case of Legionnaires' disease treated with azithromycin, complicated by elevated liver enzymes, highlighting the need for careful monitoring of liver function during treatment.