CTICasesLegionella mcdadei and Aspergillus Co-infection
Imaging findings
CT chest shows multiple pulmonary nodules, airway wall thickening, tree-in-bud opacities, and a dense, necrotizing consolidation in the right lower lobe. Brain MRI shows multifocal, ring-enhancing lesions. Sputum/BAL grew Legionella mcdadei and CSF was positive for Aspergillus.
Key takeaways
Immunocompromised hosts can present with atypical, necrotizing bacterial pneumonias like Legionella mcdadei (formerly Pittsburgh pneumonia agent), which can mimic or coexist with fungal infections like invasive aspergillosis. Cerebral involvement (ring-enhancing lesions) is highly characteristic of hematogenous dissemination of Aspergillus.
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