Case Report: Legionella Necrotising Pneumonia in a Diabetic Patient-A Clue to Co-Infection?

Computerised tomography findings in patients with Legionella pneumonia usually demonstrate airspace consolidation and/or ground glass opacities (GGO). Associated necrosis, abscess formation, or cavitation are usually limited to patients who are clearly immunocompromised.

We report a recent patient who was immunocompetent, other than controlled type 2 diabetes, and had hospital-acquired severe Legionella pneumonia. The patient was found to have pulmonary necrosis and bacterial co-infection with Acinetobacter.

The patient underwent endotracheal intubation and mechanical ventilation, and was treated with intravenous azithromycin and colistin. However, the patient's condition continued to deteriorate, and she eventually died from multiple organ failure.

The unusual appearance of necrotising pneumonia in Legionnaires' disease patients without frank immunosuppression may signify a co-infection with other microorganisms, which must be sought.