Clinico‑Radiologic Probable Acute Haemorrhagic Leukoencephalitis Triggered by Legionella Pneumonia

Acute haemorrhagic leukoencephalitis (AHLE) is a rare disease characterised by focal neurological symptoms, commonly following a fulminant course and progressing to coma or, in some cases, death. Although the exact pathophysiology is unclear, AHLE commonly follows infections and is thought to be a post-infectious autoimmune demyelinating neuropathy. Therefore, the mainstay of treatment is immunosuppression. We report a rare case of a 66-year-old male smoker with severe Legionella pneumonia requiring intubation and ventilation, who subsequently developed a reduced Glasgow Coma Scale (GCS) and generalised weakness. Magnetic resonance imaging (MRI) demonstrated extensive symmetrical microhaemorrhages consistent with AHLE. Based on clinical and radiological findings, he was treated with intravenous steroids and plasma exchange, ultimately making a full recovery with normal GCS and normal limb power.