CLINICAL IMAGE
An 83-year-old woman, living alone, visited our emergency department
with consciousness disorder, high fever (39.3oC), and
hypoxemia. She had been discharged only 5 days earlier after 10 days of
hospitalization for COVID-19. Examination data revealed high
inflammatory responses with acute kidney injury. Chest X-ray and CT
demonstrated features of severe pneumonia, mainly in the right lobe
(Figure 1), which are obviously distinct from those of COVID-19 (Figure
2). The SARS-CoV-2 antigen was negative, but urinary Legionellaantigen was positive; Legionella pneumonia was diagnosed. Her
sputum disclosed Legionella pneumophila (serogroup 5). Treatment
with antibiotics was successful. The patient gradually recovered and was
transferred to a long-term hospital on day 68. In addition,Legionella pneumophila was also detected in her daily
reused bathtub water. This very common lifestyle in Japan can be a
hotbed of Legionella infection in this case. Furthermore,
increasing concerns on the Legionnaires’ disease are warned in
association with release or relaxation from lockdown after the burning
down of COVID-19 pandemic.1,2 Infectious diseases such
that caused by Legionella should also be considered for patients
after discharge.