Fulminant legionellosis in two patients treated with infliximab for Crohn's disease: case series and literature review

Abstract

Two cases of fulminant pulmonary legionellosis, complicated by prolonged intensive care unit stays and acute respiratory distress syndrome, and who were recently treated with infliximab for Crohn's disease, are described. A review of the literature revealed three additional cases in patients with inflammatory bowel disease, and a total of 22 cases of Legionella pneumophila pneumonia in the context of treatment with antitumour necrosis (TNF)-alpha medications. The median age of the patients was 49 years, and men and women were affected equally. The case fatality rate was 14% (three of 22). Early recognition and treatment of this anti-TNF-alpha-related complication would likely result in reduced mortality and morbidity. Physicians prescribing anti-TNF-alpha drugs should be aware of this association.

Figure 1)

A The patient in case A presented in acute respiratory distress following Legionella pneumophila infection, subsequent to infliximab therapy. His initial chest x-ray demonstrates diffuse bilateral patchy infiltrates. B The lower cuts on a chest computed tomography scan in the infliximab-associated L pneumophilia infection in case B demonstrate ground-glass opacities, airspace disease and bilateral pleural effusions, right greater than left. An abscess was also found in the posterobasal segment of the right upper lobe