Legionnaires' disease with severe hypoxemia and saddleback fever

In the case of Legionnaires' disease described, severe respiratory problems necessitated mechanical ventilatory support, tracheal intubation, and positive end-expiratory pressure. Fever was eliminated with erythromycin therapy but returned after five days, and lung infiltrates spread. After supplementary treatment with other antibiotics and methylprednisolone sodium succinate, both the fever and the infiltrates disappeared. We feel that the multisystem involvement and the recrudescence of fever in our patient emphasize the wide spectrum of characteristics of Legionnaires' disease and the importance of continuation of antibiotics for a prolonged period to eradicate infection.