Atypical Legionnaires' Disease in the Setting of Suspected Recurrent Lung Cancer

Legionnaires’ disease is a type of pneumonia caused by Legionella bacteria. This type of bacteria can be found anywhere across the world, mostly in moist environments (e.g., ground soil, rivers, lakes). More importantly, Legionella can multiply in water systems such as air conditioners, which is a common source of outbreaks nationwide, particularly during the summer months. We present a unique clinical course of Legionnaires’ disease with suspected underlying recurrent lung cancer in a 77-year-old man during an outbreak that originated in a small city near our hospital. The patient presented to Urgent Care and after initial assessment, was admitted to the Internal Medicine Unit. He underwent supportive treatment with antibiotic therapy and oxygen, and was discharged one week after admission with improvement. The patient returned to Urgent Care a few weeks later with worsening dyspnea, where he was then transferred to another hospital for admission to the Intensive Care Unit (ICU), and later died. We report this special case to bring awareness to physicians of the possibility and importance of early detection and prompt management of Legionnaires’ disease in lung cancer and critically ill patients with possible environmental risk factors. Prompt detection and management of Legionella pneumophila allows for a greater chance of a favorable prognosis, particularly in the immunocompromised.