Pol. Merkur. Lek (Pol. Med. J.), 2020, XLVIII/283: 060-064 Maximize

Pol. Merkur. Lek (Pol. Med. J.), 2020, XLVIII/283: 060-064

Title: Asymptomatic cardiac and gallbladder involvement at initial presentation of Legionnaires’ disease 

Authors: Elikowski W, Małek-Elikowska M, Ganowicz-Kaatz T, Fertała N, Zawodna M, Pyda M. 

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Asymptomatic cardiac and gallbladder involvement at initial presentation of Legionnaires’ disease

Elikowski W1, Małek-Elikowska M2, Ganowicz-Kaatz T3, Fertała N1, Zawodna M1, Pyda M4.

Józef Struś Hospital, Poznań, Poland: 1Department of Internal Medicine; 3Department of Cardiology; Poznań University of Medical Sciences, Poland: 22nd Department of Cardiology, 4Cardiac Magnetic Resonance Unit, 1st Department of Cardiology

Extrapulmonary manifestations of Legionnaires’ disease (LD) include, inter alia cardiac, brain, abdominal, joints and skin involvement.
A case report
. The authors describe a case of a 41-year-old immunocompetent female admitted due to a high fever, chills and fatigue. She negated cough and chest or abdominal pain. Initial chest X-ray was normal. Among laboratory abnormalities were: elevation of C-reactive protein, procalcitonin, transaminases and creatinine, hyponatremia, low white blood cell and platelet count and a moderate proteinuria. ECG showed subtle ST elevation. Echocardiography revealed normal left ventricular (LV) contractility and near normal longitudinal strain, mild myocardial thickening, and a small pericardial effusion; additionally, in subcostal view, gallbladder wall thickening (GBWT) was found. Positive L. pneumophila urinary antigen test confirmed LD diagnosis. Control Xray and CT showed development of pleural effusion and bilateral pulmonary infiltrations. Clinical and radiologic improvement of the disease was achieved with ciprofloxacin therapy started from admission. ECG abnormalities persisted for only 5 days, GBWT resolved after 9 days, pericardial effusion disappeared after 10 days; normalization of LV thickness and an increase in longitudinal strain was found within 2 weeks. However, cardiac magnetic resonance (CMR) performed after a month revealed focal midmyocardial and linear subepicardial late gadolinium enhancement (LGE).
. The authors underline the fact that being aware of extrapulmonary LD, also silent, may allow to diagnose the disease, especially when pulmonary involvement is initially absent.

Key words: Legionella pneumophila, Legionnaires’ disease, extrapulmonary manifestation, pericardial effusion, pleural effusion, longitudinal strain, cardiac magnetic resonance, late gadolinium enhancement, transient gallbladder wall thickening

Pol Med J, 2020; XLVIII (283); 60–64