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Abstract Details

Encephalopathy with restricted diffusion in the splenium of corpus callosum in a case of Legionella Pneumophilia infection
Infectious Disease
P13 - Poster Session 13 (5:30 PM-6:30 PM)
13-014
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Reported cases of Legionella continue to increase in the United States. Per CDC, there were over 7000 cases in 2017, whereas only 3522 in 2009. Legionella accounts for 2-15% of pneumonias requiring hospitalization, but diagnosis is often delayed due to varied clinical presentations, often with multiorgan system involvement and minimal pulmonary issues. Between 40-50% of patients have neurologic manifestations, including headache, confusion, psychosis, seizures, ocular movement abnormalities, and cerebellar signs. While CSF studies and MRI are often normal, there have been a handful of cases reporting Legionella in association with mild encephalitis/encephalopathy with reversible splenial lesion (MERS).
A 38-year-old man with no significant past medical history presented with 2 days of fever, nausea, emesis, mild cough and profound watery diarrhea. Over the next few days, he developed generalized weakness, headache, progressively worsening confusion/lethargy, urinary and bowel incontinence. He was febrile to 102.7F, had disinhibited affect, difficulty with higher executive functions, and bilateral dysmetria. He had mild leukocytosis, thrombocytopenia, and lactic acidosis; acute renal failure and rhabdomyolysis followed. Lumbar puncture was notable for elevated glucose at 83 (ref 50-70). MRI showed restricted diffusion in the splenium of corpus callosum without enhancement, while chest CT identified left lower lobe infiltrate. HIV testing was negative. A diagnosis of Legionnaires disease was made, confirmed by urine antigen testing, and he was treated with azithromycin/levofloxacin. His neurologic exam gradually improved. Follow-up MRI showed resolution of previously seen corpus callosum abnormalities.
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Legionella can be a challenging diagnosis, especially if patients present with neurologic symptoms while having subtle pulmonary findings. Here, we described a patient with encephalopathy associated with a reversible splenial lesion in confirmed Legionnaires disease. MERS has been previously associated with a myriad of infectious and noninfectious causes, but only a handful of case reports indicate Legionella as a possible agent. 
Authors/Disclosures
Magdalena Stepien, MD (Advent Health Neurology)
PRESENTER 		No disclosure on file