CTICasesMass-Like Legionella pneumophila Pneumonia
Imaging findings
A patient after CAR T-cell therapy, with a remote fungal infection on the left (now quiescent and shrunken), developed a new ill-defined dense infiltrate in the right hemithorax with a mass-like component, surrounding ground glass, and faint possible bird's-nest features, along with symptoms of infection. Lavage initially grew nothing (a concern for missed mucor), then grew Legionella pneumophila, likely a non-serotype-1 strain given a negative urine antigen.
Key takeaways
A dense, mass-like consolidation in an immunocompromised patient raises concern for mucormycosis (especially if lavage is initially negative, as mucor is tissue-embedded and washes out poorly) and for Legionella micdadei, which can look fungal and mass-like. Here it proved to be Legionella pneumophila, probably a non-serotype-1 strain (negative urine antigen), reminding that Legionella can present as a dense blob mimicking fungal disease.
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