Legionella Pneumophilla Infection Masquerading as Acute Cholecystitis

Abstract

Legionella pneumophilla represents a relatively common cause of community acquired pneumonia with high mortality related burden if not promptly diagnosed and treated with appropriate antibiotics. Clinical characteristics of Legionella infection are often non-specific making accurate diagnosis challenging. We report a case of a middle aged immunocompetent woman referred to our department via her gene ral practitioner with a history of fever and abdominal pain located in the right upper abdominal quadrant. Initial diagnostic work up disclosed a moderate elevation of inflammation markers and chololithiasis. The paucity of respiratory symptoms led initially to an altered presumed diagnosis of acute cholecystitis. Development of pulmonary symptoms during hospitalization raised the suspicion of Legionella community acquired pneumonia. The diagnosis was later confirmed by serology.

Figure 1

Figure 1. Abdominal ultrasound on admission showing dilatation of the common bile duct.

Figure 2

Figure 2. Computed tomography thoracic scan showing a large mass.

Figure 3

Figure 3. Follow up computed tomography thoracic scan disclosing complete resolution of the mass.