A Case of Legionnaires' Disease and Branhamella catarrhalis Pneumonia Complicated with Malignant Lymphoma

A 44-year-old female addmitted to Sasebo Kyosai Hospital for high fever, cough and sputum. A chest roentgenograph showed right lower lobe infiltrates and pleural effusion. She was treated by β-lactam antibiotics at first, but after diagnosed as Legionnaires' disease with positive culture of L. pneumophila from pleural effusion, the antibiotics were changed to minocycline (200 mg, daily) and erythromycin (1.6 g, daily). The patient became afebrile by 24 hours after erythromycin administration. The laboratory findings and chest roentgenogram findings were gradually changed to normal. About one month later, the cervical and axillary lymphadenopathy was revealed and she was diagnosed histologically as reticulim cell sarcoma. The combination therapy of antineoplastica (adriamycin, vincristin and cyclophosphamide) and predonisolone was started for the disease. The days after the treatment, severe neutropenia due to the antineoplastica occurred and she had high fever again. Her chest X-ray showed infiltrative shadow on the middle of the left lung field. By the detection of intraneutrophile gram negative cocci in her sputum and positive culture of Branhamella catarrhalis, the patient was diagnosed as Branhamella catarrhalis pneumonia. Although many antibiotics such as minocycline, mezlocillin, cefmetazole, piperacillin and cephoperazon were administered, the patient was getting to severe respiratory failure and died. Indirect immunofluorescent antibody (IFA) titer of her serum to L. pneumophila, serogroup 1 was always within 1: 32 with no significant elevation.