Recurrent infection of Legionella pneumonia: a case report

A 75-year-old male veteran presented with bilateral pneumonia upon admission. He had an episode of Legionnaires' disease in 1991 with complete treatment of erythromycin 500 mg orally every six hours for three weeks. After admission, recurrence of Legionnaires' disease was suspected due to increased serum Legionella antibody (1:128) and strong positive sputum Legionella antigen. Erythromycin and other parental antibiotics were administered, but respiratory failure developed promptly, followed by multiple organ failure syndrome that involved the liver, lung, bone marrow and kidney. He died 42 days after admission. We reviewed seven cases that had been reported and found recurrence of Legionella pneumonia possible after a successful treatment, especially for immunocompromised hosts. Early empirical therapy with erythromycin is recommended.