{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T22:43:31Z","timestamp":1783464211338,"version":"3.55.0"},"reference-count":29,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,4,22]]},"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:p>A 34-year-old woman is admitted to the hospital with dyspnoea, dry cough and left-sided flank pain. Her <jats:italic>Legionella<\/jats:italic> urinary test was positive and CT imaging demonstrated multifocal pneumonia with pulmonary abscesses. Although she had initial clinical improvement on appropriate antibiotic therapy, her hospital course was complicated by worsening flank pain, hypoxemia and leucocytosis, prompting clinical re-evaluation and assessment for development of complications involving the pleural space. CT imaging revealed interval development of a loculated complicated parapneumonic effusion. Successful treatment required chest tube drainage assisted by fibrinolytic therapy. This case highlights the importance of considering <jats:italic>Legionella<\/jats:italic> in patients with pulmonary abscess, demonstrates an approach to a patient with a non-resolving pneumonia and illustrates the management of parapneumonic effusions.<\/jats:p>","DOI":"10.1136\/bcr-2021-243026","type":"journal-article","created":{"date-parts":[[2021,5,24]],"date-time":"2021-05-24T11:56:42Z","timestamp":1621857402000},"page":"e243026","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["<i>Legionella<\/i> pulmonary abscess and pleural space infection in an immunocompetent patient"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6941-9385","authenticated-orcid":false,"given":"Kristen L","family":"Flint","sequence":"first","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9810-0437","authenticated-orcid":false,"given":"Maxwell R","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2918-3045","authenticated-orcid":false,"given":"Polly","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9287-4503","authenticated-orcid":false,"given":"Zahir","family":"Kanjee","sequence":"additional","affiliation":[{"name":"Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA"},{"name":"Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,5,24]]},"reference":[{"key":"2025082723444337000_14.5.e243026.1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciz538"},{"key":"2025082723444337000_14.5.e243026.2","first-page":"524","article-title":"Legionnaires' disease causing severe lung abscesses","volume":"123","author":"Edwards","year":"1980","journal-title":"Can Med Assoc J"},{"key":"2025082723444337000_14.5.e243026.3","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/190183"},{"key":"2025082723444337000_14.5.e243026.4","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.arbres.2011.10.005","article-title":"Empyema caused by Legionella pneumophila","volume":"48","author":"Ferrufino","year":"2012","journal-title":"Arch Bronconeumol"},{"key":"2025082723444337000_14.5.e243026.5","first-page":"547","article-title":"Absceso pulmonar y empiema pleural por Legionella pneumophila en un paciente trasplantado renal [Pulmonary abscess and pleural empyema caused by Legionella pneumophila in kidney transplant recipient]","volume":"10","year":"1993","journal-title":"An Med Interna"},{"key":"2025082723444337000_14.5.e243026.6","doi-asserted-by":"publisher","DOI":"10.1086\/515040"},{"key":"2025082723444337000_14.5.e243026.7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.2011.02508.x"},{"key":"2025082723444337000_14.5.e243026.8","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.48.2647"},{"key":"2025082723444337000_14.5.e243026.9","doi-asserted-by":"crossref","first-page":"89","DOI":"10.18683\/germs.2019.1162","article-title":"Pneumonia and pulmonary abscess due to Legionella micdadei in an immunocompromised patient","volume":"9","author":"Foissac","year":"2019","journal-title":"Germs"},{"key":"2025082723444337000_14.5.e243026.10","first-page":"315","article-title":"Legionella-Associated lung abscess: critical pathogen or minor isolate?","volume":"3","author":"Dow","year":"1992","journal-title":"Can J Infect Dis"},{"key":"2025082723444337000_14.5.e243026.11","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-90-4-533"},{"key":"2025082723444337000_14.5.e243026.12","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1128\/jcm.30.2.512-513.1992","article-title":"Abscess and empyema caused by Legionella micdadei","volume":"30","author":"Halberstam","year":"1992","journal-title":"J Clin Microbiol"},{"key":"2025082723444337000_14.5.e243026.13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-3062.2004.00053.x"},{"key":"2025082723444337000_14.5.e243026.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0163-4453(85)91010-2"},{"key":"2025082723444337000_14.5.e243026.15","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199801150-00025"},{"key":"2025082723444337000_14.5.e243026.16","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1979.03290320039029"},{"key":"2025082723444337000_14.5.e243026.17","first-page":"128","article-title":"Legionella and immunosuppression","volume":"13","author":"Schlossberg","year":"1998","journal-title":"Semin Respir Infect"},{"key":"2025082723444337000_14.5.e243026.18","first-page":"220","article-title":"Legionella micdadei lung abscess in a patient with HIV-associated nephropathy","volume":"93","author":"Nzerue","year":"2001","journal-title":"J Natl Med Assoc"},{"key":"2025082723444337000_14.5.e243026.19","doi-asserted-by":"publisher","DOI":"10.1378\/chest.111.1.252"},{"key":"2025082723444337000_14.5.e243026.20","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.ijid.2018.01.024","article-title":"Legionella indianapolisensis sp. nov., isolated from a patient with pulmonary abscess","volume":"69","author":"Relich","year":"2018","journal-title":"Int J Infect Dis"},{"key":"2025082723444337000_14.5.e243026.21","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.37.3.785-787.1999"},{"key":"2025082723444337000_14.5.e243026.22","doi-asserted-by":"crossref","first-page":"99","DOI":"10.5492\/wjccm.v8.i6.99","article-title":"Fatal Legionella pneumophila serogroup 1 pleural empyema: A case report","volume":"8","author":"Maillet","year":"2019","journal-title":"World J Crit Care Med"},{"key":"2025082723444337000_14.5.e243026.23","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00176-10"},{"key":"2025082723444337000_14.5.e243026.24","doi-asserted-by":"crossref","first-page":"145","DOI":"10.7326\/0003-4819-105-1-146_2","article-title":"Legionella bozemanii and empyema","volume":"105","author":"Brettman","year":"1986","journal-title":"Ann Intern Med"},{"key":"2025082723444337000_14.5.e243026.25","doi-asserted-by":"crossref","first-page":"e220","DOI":"10.1016\/j.oooo.2018.02.011","article-title":"Radiculomegaly: a case report of this rare dental finding with review of the associated oculo-facio-cardio-dental syndrome","volume":"126","author":"Smith","year":"2018","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"key":"2025082723444337000_14.5.e243026.26","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.idc.2012.11.009","article-title":"What is the best approach to the nonresponding patient with community-acquired pneumonia?","volume":"27","author":"Sialer","year":"2013","journal-title":"Infect Dis Clin North Am"},{"key":"2025082723444337000_14.5.e243026.27","doi-asserted-by":"publisher","DOI":"10.1513\/pats.200510-113JH"},{"key":"2025082723444337000_14.5.e243026.28","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00440180068008"},{"key":"2025082723444337000_14.5.e243026.29","first-page":"ii41","article-title":"Management of pleural infection in adults: British thoracic Society pleural disease guideline 2010","volume":"65 Suppl 2","author":"Davies","year":"2010","journal-title":"Thorax"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-243026","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:44:53Z","timestamp":1756363493000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-243026"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5]]},"references-count":29,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,5,24]]},"published-print":{"date-parts":[[2021,5]]}},"alternative-id":["10.1136\/bcr-2021-243026"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-243026","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5]]}}}