{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T00:05:42Z","timestamp":1756339542607,"version":"3.44.0"},"reference-count":10,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,1,5]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:p>We present a case of Legionnaires\u2019 disease complicated by cerebellar ataxia. A 60-year-old man was diagnosed with Legionnaires\u2019 disease by urine antigen after presenting to the hospital with a main problem of headache and gait instability. He also had a productive cough, as well as nausea, vomiting and diarrhoea. Initial physical examination revealed a positive Romberg test, positive pronator drift, severely unsteady gait and bilateral upper extremity resting tremors with the remainder of cranial nerves and neurological examination being unremarkable. The patient had a prolonged hospital course requiring endotracheal intubation and mechanical ventilation. He received 14 days of levofloxacin with resolution of the pneumonia. On repeat assessment prior to discharge, the patient\u2019s neurological symptoms improved; however, he still had mild residual gait instability, dysdiadokinesia and difficulty with fine motor tasks such as writing. Romberg test remained positive.<\/jats:p>","DOI":"10.1136\/bcr-2019-230710","type":"journal-article","created":{"date-parts":[[2020,3,11]],"date-time":"2020-03-11T05:10:28Z","timestamp":1583903428000},"page":"e230710","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebellar ataxia a unique initial presentation of Legionnaires\u2019 disease"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5129-0931","authenticated-orcid":false,"given":"Zaid","family":"Kaloti","sequence":"first","affiliation":[{"name":"Internal Medicine, Wayne State University, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3098-0882","authenticated-orcid":false,"given":"Kendall","family":"Bell","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mowyad","family":"Khalid","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diane","family":"Levine","sequence":"additional","affiliation":[{"name":"Internal Medicine, Wayne State University, Detroit, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,3,10]]},"reference":[{"key":"2025082710202345000_13.3.e230710.1","doi-asserted-by":"publisher","DOI":"10.1097\/01.SMJ.0000104843.78816.49"},{"key":"2025082710202345000_13.3.e230710.2","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1097\/00005792-198409000-00004","article-title":"Neurologic manifestations of Legionnaires\u02bc disease","volume":"63","author":"Johnson","year":"1984","journal-title":"Medicine"},{"key":"2025082710202345000_13.3.e230710.3","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.62.1.51"},{"key":"2025082710202345000_13.3.e230710.4","first-page":"1","article-title":"Two Cases of Legionella pneumophila Pneumonia with Prolonged Neurologic Symptoms and Brain Hypoperfusion on Single-Photon Emission Computed Tomography","volume":"2016","author":"Ohta","year":"2016","journal-title":"Case Rep Infect Dis"},{"key":"2025082710202345000_13.3.e230710.5","doi-asserted-by":"crossref","unstructured":"Kunimasa K , Saigusa M , Yamada T , et al . Reversible lesion in the splenium of the corpus callosum associated with Legionnaires' pneumonia. BMJ Case Rep 2012;2012. doi:doi:10.1136\/bcr.11.2011.5096. [Epub ahead of print: 21 Feb 2012].","DOI":"10.1136\/bcr.11.2011.5096"},{"key":"2025082710202345000_13.3.e230710.6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1007\/s15010-006-4131-y","article-title":"Brainstem Involvement in Legionnaires\u2019 Disease","volume":"34","author":"Morelli","year":"2006","journal-title":"Infection"},{"key":"2025082710202345000_13.3.e230710.7","doi-asserted-by":"crossref","DOI":"10.7326\/0003-4819-90-4-624","article-title":"\"Endotoxicity\" of the Legionnaires' disease bacterium","volume":"90","author":"Wong","year":"1979","journal-title":"Ann Intern Med"},{"key":"2025082710202345000_13.3.e230710.8","unstructured":"Friedman RL , Iglewski BH , Miller RD . Identification of a cytotoxin produced by Legionella pneumophila. Available: https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC551106\/ [Accessed 28 Dec 2019]."},{"key":"2025082710202345000_13.3.e230710.9","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1128\/jcm.9.3.453-456.1979","article-title":"Exotoxin activity associated with the Legionnaires disease bacterium","volume":"9","author":"Baine","year":"1979","journal-title":"J Clin Microbiol"},{"key":"2025082710202345000_13.3.e230710.10","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.2174\/1871527316666171123210420","article-title":"Innate immune surveillance in the central nervous system following Legionella pneumophila infection","volume":"16","author":"Lagana","year":"2018","journal-title":"CNS Neurol Disord Drug Targets"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-230710","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:20:33Z","timestamp":1756315233000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-230710"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3]]},"references-count":10,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,3,10]]},"published-print":{"date-parts":[[2020,3]]}},"alternative-id":["10.1136\/bcr-2019-230710"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-230710","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,3]]}}}