Cerebellar syndrome associated with legionellosis: A case report and literature review |
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| Affiliation: | 1. Department of Infective and Tropical Diseases and Internal Medicine, University Hospital of la Reunion, Saint-Pierre, Reunion;2. Inserm CIC1410, University Hospital of Reunion Island, Saint-Pierre, Reunion;3. Department of Microbiology, University Hospital of Reunion Island, Saint-Pierre, Reunion;1. Service de médecine Physique et de Réadaptation, Garches, AP–HP, Université Paris Saclay, Hôpital Raymond Poincaré, Paris, France;2. U1179 END-ICAP, Inserm, UFR Simone Veil–Santé, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Université Paris Saclay, Montigny-le-Bretonneux, France;3. ISPC Synergies, Paris, France;4. Groupe de recherche en neuro-orthopédie de Garches (GRENOG), Garches, France;5. Sorbonne Université, Unité de Médecine Intensive Réanimation à orientation neurologique, Département de Neurologie, DMU Neurosciences, Hôpital de la Pitié-Salpêtrière, AP–HP.Sorbonne Université, Paris, France;6. U1016, UMR8104, Institut Cochin, Inserm, CNRS, Université de Paris, Paris, France;7. Département de Neurophysiologie Clinique, AP–HP, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France;8. Sorbonne Université, Groupe de Recherche Clinique en RÉanimation et Soins intensifs du Patient en Insuffisance Respiratoire aiguË (GRC-RESPIRE), Paris, France;9. UMR-S 938 Centre de Recherche de Saint-Antoine, INSERM, Sorbonne Université, Paris, France;10. Sorbonne Université, Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, Paris, France;1. Université de Paris, IFSI Beaujon, Clichy, France;2. Département de Médecine Interne, hôpital Bichat, AP–HP, 46, rue Henri-Huchard, 75018, Paris, France;3. Université de Paris, IFSI Camille Claudel, Argenteuil, France;4. Departement de médecine interne, hôpital Beaujon, Assistance Publique HOPITAUX de Paris, Université de Paris, Paris, France;5. UMR 1123 ECEVE–INSERM, Université de Paris, Paris, France;6. Laboratoire d’hématologie, Inserm UMR-1160, Institut de recherche Saint-Louis, hôpital Saint-Louis, Assistance Publique hôpitaux de Paris, Université de Paris, Paris, France;1. Université de Lille, CHU de Lille, departement de medecine interne et d’immunologie clinique, centre national de reference maladies systemiques et auto-immunes rares nord et nord-ouest de France (CeRAINO), european reference network on rare connective tissue and musculoskeletal diseases network (ReCONNECT), 59000 Lille, France;2. Inserm, UMR 1167, RID-AGE, 59000 Lille, France;1. Service de médecine interne, hôpital de la Croix-Rousse, hospices civils de Lyon, université Claude-Bernard Lyon 1, 69004 Lyon, France;2. Université Claude Bernard Lyon 1, research on healthcare performance (Reshape), Inserm U1290, Lyon, France;1. CHU de Bordeaux, pôle produits de santé, service pharmacie à usage intérieur, 33600 Pessac, France;2. Université de Bordeaux, Inserm, biologie des maladies cardiovasculaires, U1034, 33600 Pessac, France;1. Centre de néphrologie et transplantation rénale, AP-HM, CHU de la Conception, 147, boulevard Baille, 13005 Marseille, France;2. Laboratoire d’immunogénétique, EFS Alpes Méditerrannée, Marseille, France;3. CRPV Marseille Provence Corse, service hospitalo-universitaire de pharmacologie clinique et pharmacovigilance, AP-HM, Marseille, France;4. Service d’anatomie et cytologie pathologiques et neuropathologie, AP-HM, CHU de la Timone, Marseille, France;5. C2VN, Inserm 1263, Institut national de la recherche agronomique (INRA) 1260, faculté de Pharmacie, Marseille, France |
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| Abstract: | IntroductionLegionnaire's disease is a community-acquired pneumonia caused by the Gram-negative bacterium Legionella pneumophila. This disease is often associated with neurological symptoms, the clinical presentation of which can be very varied.Case reportWe report a 47-year-old female patient who developed Legionnaires’ disease with cerebellar symptoms (ataxia, dysarthria and hypermetria). Laboratory tests revealed a biological inflammatory syndrome. The cerebrospinal fluid was sterile. Urinary antigen test and serology were positive for L. pneumophila. An interstitial syndrome of the right upper lobe was detected on chest computed tomography (CT) scan. Brain imaging (magnetic resonance imaging and CT angiography) showed no abnormalities. The outcome was favourable after treatment with spiramycin, levofloxacin and corticosteroids.DiscussionFew cases only (n = 110) of Legionnaires’ disease with cerebellar symptoms have been reported in the literature. The pathogenic mechanism behind neurological dysfunction in patients with Legionnaires’ disease is unknown. Neurological symptoms improve with antibiotic therapy and corticosteroids. Extra-pulmonary forms of Legionnaires’ disease are frequent, with neurological symptoms being the most common symptoms. Cerebellar dysfunction may be underestimated and requires appropriate management with antibiotic therapy and corticosteroid therapy. Recommendations for the management of Legionnaire's disease with severe extra-pulmonary symptoms are needed. |
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