CTICasesLegionella pneumophila Round Pneumonia Mimicking Fungal Infection After Bone Marrow Transplant
Imaging findings
In a young woman roughly 60 days after bone marrow transplant, a new subtle consolidation develops near the hilum; CT shows a new, round area of consolidation with a low-attenuation center suggestive of early cavitation, initially favored to represent a fungal round infection such as Aspergillus. Follow-up imaging days later shows progression to more extensive left lower lobe consolidation with a new pleural effusion.
Key takeaways
A round, cavitating pulmonary infection in an immunocompromised host is not always fungal -- here, sputum and environmental (sink water) cultures grew Legionella pneumophila, which along with Legionella micdadei should be kept on the differential for a round infection that progresses faster than the typical Aspergillus timeline; the causative water source was traced and the affected room's plumbing was subsequently shut down.
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