CTICasesFulminant Legionella pneumophila Pneumonia with Rapid Bilateral Progression
Imaging findings
A previously healthy young man presents with fever, cough, and an elevated white count. Serial chest radiographs over less than 48 hours show unilateral left lower lobe consolidation that rapidly becomes multilobar and then bilateral, with the patient requiring intubation and developing hypotension over this same short interval.
Key takeaways
Rapid progression from unilateral to bilateral consolidation within 48 hours, culminating in respiratory failure, is a recognized pattern of severe Legionella pneumophila pneumonia (confirmed here by positive sputum PCR); Legionella characteristically starts as a lobar process but disseminates quickly because it behaves as a bronchopneumonia, which is why these patients can decompensate so fast.
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