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Legionnaires' disease combined with erythema multiforme in a 3-year-old boy
Insights
This case study details a 3-year-old boy with severe Legionnaires' disease (LD) caused by Legionella pneumophila. A rare complication, erythema multiforme, emerged, possibly linked to a co-infection with respiratory syncytial virus (RSV).
Area of Science:
- Infectious Diseases
- Pediatrics
- Dermatology
Background:
- Legionnaires' disease (LD) is a severe bacterial pneumonia typically caused by Legionella pneumophila.
- Pediatric LD is rare, and fulminant cases with central nervous system involvement are exceptionally uncommon.
- Erythema multiforme is an acute, immune-mediated hypersensitivity reaction, most often triggered by infections.
Observation:
- A 3-year-old boy presented with fulminant LD, including bilateral pneumonia, gastrointestinal distress, and neurological symptoms.
- The patient developed erythema multiforme, a dermatological manifestation not previously reported in LD.
- Respiratory syncytial virus (RSV) was identified early, with a delayed serological response, suggesting a possible co-infection.
Findings:
- Legionella pneumophila was confirmed as the causative agent of LD through serological testing.
- The co-occurrence of LD and erythema multiforme in this pediatric case is novel.
- A successive viral (RSV) infection may have influenced the disease's prolonged course and contributed to the erythema multiforme.
Implications:
- This case expands the known clinical spectrum of Legionnaires' disease in children.
- It highlights the potential for unusual dermatological manifestations in severe pediatric infections.
- The interplay between bacterial and viral infections warrants further investigation in complex pediatric cases.
Abstract:
A case of Legionnaires' disease (LD) is described in a 3-year-old boy. He had fulminant disease with typical signs like bilateral pneumonia, gastrointestinal symptoms, and somnolence indicating involvement of the central nervous system. There was no premorbidity. An outstanding development was erythema multiforme, which has never previously been described in LD. The basic disease was caused by Legionella pneumophila. This is evidenced by specific serum IgM at admission and a subsequent significant rise in titers against L. pneumophila. At an early stage respiratory syncytial virus (RSV) was isolated from the patient's throat, although there was no antiviral serological response at the outset of erythema multiforme or 3 weeks after onset of disease; anti-RSV appeared later. The prolonged course of the disease can be explained by the successive occurrence of two infections. The possibility that the virus could have contributed to the development of erythema multiforme cannot be ruled out. The role of concomitant medication cannot be separated out, but on the basis of general knowledge of their immunogenicity and the fact that immunosuppressive cortisone was given at the time it is less likely that the antibiotics contributed significantly.