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Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVII/277: 019-024 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2019, XLVII/277: 019-024

Title: Severe transient left ventricular dysfunction in a patient with Legionella pneumophila pneumonia 

Authors: Elikowski W, Małek-Elikowska M, Greberska W, Fertała N, Zawodna M, Marchlewska J, Dudziak J. 

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SUMMARY IN POLISH & ENGLISH. FULL ARTICLE ONLY IN ENGLISH.

Severe transient left ventricular dysfunction in a patient with Legionella pneumophila pneumonia


Elikowski W1, Małek-Elikowska M2, Greberska W3, Fertała N1, Zawodna M1, Marchlewska J1, Dudziak J3.

Józef Struś Hospital, Poznań, Poland: 1Department of Internal Medicine; 3Department of Cardiology; Poznań University of Medical Sciences, Poland: 22nd Department of Cardiology

Legionella pneumophila infection (legionellosis) usually presents as a multisystemic disease, predominantly affecting the lungs (Legionnaires’ disease – LD). Immunodeficiency, chemotherapy or chronic steroids use increase the risk of developing LD. Extrapulmonary manifestations of LD include cardiac complications: myocarditis, pericarditis or endocarditis.
A case report
. The authors describe a case of a 51-year-old female with a history of cryoglobulinemic vasculitis, Sjögren syndrome and chronic lymphocytic leukemia who was admitted due to a high fever, fatigue, tachycardia, dyspnea and cough. Chest X-ray and CT showed bilateral pulmonary infiltrations and pleural effusion. LD was diagnosed on positive L. pneumophila urinary antigen test. Echocardiography revealed severe left ventricular (LV) dysfunction with substantially decreased ejection fraction and global longitudinal strain (GLS), with a pattern resembling reverse takotsubo syndrome (rTTS). The coronary arteries in non-invasive coronary angiography were normal. During therapy with levofloxacin and intravenous immunoglobulins as well as with carvedilol, ramipril and diuretics, gradual clinical improvement with complete normalization of LV function was observed within 5 weeks. Cardiac magnetic resonance (CMR) performed on day 35 revealed only small intramural foci of late gadolinium enhancement (LGE) with localization not corresponding to the most decreased regional longitudinal strain in the initial echocardiographic examination. The authors suggest that the mechanism of transient LV dysfunction in the case presented may have been of complex nature, including LD myocarditis and stress-induced cardiomyopathy (with the prevalence of the latter) which has not so far been reported in the literature.

Key words: Legionella pneumophila, Legionnaires’ disease, transient left ventricular dysfunction, reversible heart failure, myocarditis, stressinduced cardiomyopathy, takotsubo syndrome, longitudinal strain

Pol Med J, 2019; XLVII (277); 19–24