Severe Legionnaire's disease revealing an invasive aspergillosis in an apparently immunocompetent patient
Vergne, S.; Lathuile, D.; Bénosa, B.; Fragnier, F.; Destrac, S.; Avedan, M.; Alzieu, M.; Campistron, J.
Presse Medicale 32(34): 1604-1606
2003
ISSN/ISBN: 0755-4982 PMID: 14576582 Document Number: 559529
Invasive aspergillosis, a sever disease, usually occurs in immunodepressed patients. However, it may also develop in presumably immunocompetent patients. A 54-year-old male smoker was hospitalized for hypoxaemia of the right lung and septic shock, rapidly requiring mechanical ventilation combined with administration of vasopressors, and followed by dialysis because of the rapid worsening of an acute kidney failure. The diagnosis of pulmonary Legionnaire's disease was made on the second day in view of the positivity of the urinary Legionella antigen. The progression of the disease was marked by the discovery of a histologically documented gastric aspergillosis and three abscessed intracerebral lesions within the context of a strongly positive Aspergillus antigenaemia. The disease worsened and the patient died on day 17, despite the antibacterial and antifungal treatments, haemodynamic support and dialysis. To our knowledge, the association of invasive aspergillosis and severe Legionnaire's disease has never been described in a presumably immunocompetent patient. This clinical case suggests the existence, other than the usual risk factors of invasive aspergillosis that characterize profound states of immunodepression, of more subtle alterations in the immune system that may enhance this type of infection.