Suspected Legionella-induced perimyocarditis in an adult in the absence of pneumonia: a rare clinical entity

Abstract

Legionella infection can manifest itself in many clinical forms, most commonly as pneumonia, but rarely in the form of myocardial involvement. Legionella with myocardial involvement independent of pneumonia is almost never seen in the adult population and therefore is cited only a handful of times in the medical literature. When reported, Legionella carditis itself typically occurs as an isolated pericarditis with effusion. Cases of isolated Legionella with myocardial involvement, but without associated pneumonia, have been reported among children. To our knowledge, there are no reported cases of Legionella myocarditis and pericarditis presenting concurrently with or without pneumonia, in either an adult or a pediatric population. Herein, we report a rare manifestation of Legionella pneumophila-induced perimyocarditis (strongly suspected, if not incontrovertibly proved) in an adult, in the absence of pneumonia.

Keywords: Antibodies, bacterial; Legionella; Legionella pneumophila; Legionnaires' disease; bacterial infections/diagnosis; middle aged; myocarditis; pericarditis.

Fig. 1. Initial upright chest radiograph taken on the day of the patient's admission was negative for infiltrates suggestive of pneumonia. Thereafter, serial chest radiographs remained negative for the presence of infiltrates and for an indication of a source of infection.

Fig. 2. A) Two-dimensional transthoracic echocardiogram (subcostal view) shows a small pericardial effusion without hemodynamic significance surrounding the right ventricle in systole (arrows). B) Parasternal short-axis view of the left ventricle shows a small posterior pericardial effusion in systole (arrows).