Severe Legionella pneumophila pneumonia following infliximab therapy in a patient with Crohn's disease

TLDR: The case of a 58‐year‐old patient with Crohn's disease treated with steroids and azathioprine who developed severe Legionella pneumophila pneumonia after 3 infusions of infliximab is reported.

Abstract: Background: Immunosuppressive therapy with anti-TNF-α antibodies is effective in patients with inflammatory bowel disease (IBD) However, there is an increased risk for infections associated with this therapy Methods: Here, we report the case of a 58-year-old patient with Crohn's disease (CD) treated with steroids and azathioprine who developed severe Legionella pneumophila pneumonia after 3 infusions of infliximab The patient presented at our IBD department with severe active CD complicated by inflammatory small bowel stenoses and entero-enteral fistulas despite long-term high-dose steroid therapy To achieve steroid tapering and control of disease activity, immunosuppressive therapy with azathioprine was initiated Due to persistent symptoms, infusion therapy with the anti-TNF-α antibody infliximab was started, subsequently leading to significant clinical improvement However, after the third infliximab infusion the patient was hospitalized with fever, severe fatigue, and syncope Results: Laboratory findings and chest X-ray revealed left-sided pneumonia; cultural analysis showed L pneumophila serogroup 1 leading to respiratory insufficiency, which required mechanical ventilation for 2 weeks in the intensive care unit After discontinuation of all immunosuppressive agents and immediate antibiotic therapy the patient recovered completely Conclusions: To our knowledge, this is the third case of L pneumophila pneumonia in an IBD patient treated with infliximab Similar to other published cases, concomitant treatment of immunosuppressives and anti-TNF agents is a major risk factor for the development of L pneumophila infection, which should be ruled out in all cases of pneumonia in patients with such a therapeutic regimen Appropriate prevention strategies should be provided in these patients (Inflamm Bowel Dis 2009)