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Case Reports
. 2024 Feb 27:11:1329381.
doi: 10.3389/fmed.2024.1329381. eCollection 2024.

Multiple pulmonary cavities in an immunocompetent patient: a case report and literature review

Zihan Guo  1 , Anli Zuo  1 , Xinyi Liu  1 , Yunxiu Jiang  1 , Shuran Yang  1 , Degan Lu  1
Affiliations
Case Reports

Multiple pulmonary cavities in an immunocompetent patient: a case report and literature review

Zihan Guo et al. Front Med (Lausanne). .

Abstract

Legionella pneumonia (LP) is a relatively uncommon yet well-known type of atypical community-acquired pneumonia (CAP). It is characterized by a rapid progression to severe pneumonia and can be easily misdiagnosed. In most patients, chest computed tomography (CT) showed patchy infiltration, which may progress to lobar infiltration or even lobar consolidation. While pulmonary cavities are commonly observed in immunocompromised patients with LP, they are considered rare in immunocompetent individuals. Herein, we present a case of LP in an immunocompetent patient with multiple cavities in both lungs. Pathogen detection was performed using metagenomic next-generation sequencing (mNGS). This case highlights the unusual radiographic presentation of LP in an immunocompetent patient and emphasizes the importance of considering LP as a possible diagnosis in patients with pulmonary cavities, regardless of their immune status. Furthermore, the timely utilization of mNGS is crucial for early pathogen identification, as it provides multiple benefits in enhancing the diagnosis and prognosis of LP patients.

Keywords: Legionella; Legionella pneumonia; Legionella pneumophila; immunocompetent patient; metagenomic next-generation sequencing; pulmonary cavity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
CT scans of the thorax on the day of admission demonstrates multiple nodular and patchy infiltrates in the lungs. Nodular infiltrate in the right lung (red arrows). Nodular infiltrate in the left lung (green arrows). Patchy infiltrates in both lungs (blue arrows).
Figure 2
Figure 2
Timeline of treatment process.
Figure 3
Figure 3
Diagnosis of Legionella pneumophila infection using mNGS. The horizontal axis (abscissa) represents the genome of the Legionella bacterium and the vertical axis (ordinate) represents the number of reads detected. The red line indicates the coverage, which represents the ratio of the detected nucleic acid sequence of Legionella to the entire gene sequence of Legionella. The blue line represents the sequencing depth, which is a measure of how many times a specific segment of the Legionella genome has been detected during the sequencing process.
Figure 4
Figure 4
The repeated CT scan conducted on the fourth day after admission showed cavitary lesions in both lungs (red arrows and green arrows). Remaining patchy infiltrate in the right lung (blue arrow).
Figure 5
Figure 5
A subsequent CT scan 2 weeks later showed that the cavity in the right lung had decreased in size (red arrow), while the cavity in the left lung had slightly enlarged (green arrow). However, the thickness of the walls of both cavities had diminished, and the bilateral pulmonary infiltration indicated by the blue arrows had been resolved.
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Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The present study was supported by the Collaborative Innovation Center for Intelligent Molecules with Multi-effects and Nanomedicine (Grant No. 2019-01), Shandong Province, China.
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