A 59-year-old male with CKD was admitted to hospital and underwent a bilateral kidney transplant. During the course of his admission he developed severe hypogastric pain and frank haematuria with blood clots. Rectal swabs were taken which came back positive for Klebsiella. His inflammatory markers were also raised and a few days later the patient developed flu-like symptoms, dyspnoea as well as a new oxygen requirement. Physical examination revealed reduced breath sounds bilaterally and Chest X-ray showed bilateral pulmonary infiltrates. The patient was then started on IV antibiotics for a suspected pneumonia. Further investigations were also which revealed that the patient had a Legionella pneumophila infection, and although treatment was escalated, the patient did eventually pass away from his illness.

From left to right: 1) Environmental sampling sites of water distribution systems, and Legionella concentration, identification, and typing. 2) The hospitalisation timeline and the clinical treatments. 3) Legionella pneumophila serogroup 1 (Lp1) and Klebsiella pneumoniae (Kp) antibiotic susceptibility from (a) lung tissue fragments and (b) rectal swab sample.

Source: https://doi.org/10.3389/fmed.2022.912649

Case Summary & Questions written by Dr Ahmed Kazie

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