A case of severe Legionella pneumonia in the late stage after renal transplantation

Abstract

A 58-year-old male, who had undergone renal transplantation (his father was the donor) because of chronic nephritis 29 years ago and had lived without complications since, was admitted to hospital due to pneumonia. He developed a fever, cough, and general muscle pain 4 days before admission. On admission, he exhibited hyponatremia, liver dysfunction, and a severely elevated inflammatory response, and he was vomiting after meals. His respiratory condition worsened rapidly; therefore, on the third day after admission he was treated with PMX, and CHDF was started. On the fourth day, mechanical ventilation was started. MEPM had been administered, but then the Legionella urinary antigen was detected; therefore, the patient was diagnosed with Legionella pneumonia, and the antibiotic was changed to LVFX. In the course of this treatment, the patient developed a lung abscess as a treatment complication, and the antibiotics were changed again while interdisciplinary treatment was performed. We reported a severe case of Legionella pneumonia that arose as a complication of immunosuppressant treatment 29 years after renal transplantation.