{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T20:47:09Z","timestamp":1782852429388,"version":"3.54.5"},"reference-count":22,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"the Pharmacy Research Project of Tianqing Hospital of Jiangsu Pharmaceutical Association","award":["Q202111"],"award-info":[{"award-number":["Q202111"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Science Progress"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    infection is rare in children, and extrapulmonary manifestations are even less commonly reported. Cutaneous involvement, particularly in the form of generalized pustular eruptions, may present significant diagnostic and therapeutic challenges, especially in immunocompromised patients. We report a male infant under 6 months with X-linked severe combined immunodeficiency (XL-SCID) who presented with a disseminated pustular rash as the predominant clinical feature. Initial blood and pus cultures were negative, and empirical antimicrobial therapy showed limited clinical response. Metagenomic next-generation sequencing (mNGS) was subsequently performed and identified\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    as the causative pathogen. Based on this finding, the antimicrobial regimen was adjusted to include a macrolide antibiotic combined with trimethoprim-sulfamethoxazole (TMP-SMX), resulting in significant clinical improvement and eventual recovery. This case highlights the atypical presentation of\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    infection with predominant cutaneous manifestations in children, particularly in the context of primary immunodeficiency, and underscores the diagnostic value of mNGS in cases with inconclusive conventional testing. Early application of advanced molecular diagnostics and timely optimization of targeted antimicrobial therapy are crucial for improving outcomes in rare and complex pediatric infections.\n                  <\/jats:p>","DOI":"10.1177\/00368504261458101","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T17:01:46Z","timestamp":1780678906000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Successful management of\n                    <i>Legionella<\/i>\n                    pneumonia in an immunocompromised infant presenting with generalized pustular rash: A case report"],"prefix":"10.1177","volume":"109","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7621-3342","authenticated-orcid":false,"given":"Yuanyuan","family":"Zeng","sequence":"first","affiliation":[{"name":"Children\u2019s Hospital of Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanshan","family":"Wang","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongjun","family":"Miao","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Xu","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1684-4390","authenticated-orcid":false,"given":"Wenjing","family":"Li","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital of Nanjing Medical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"e_1_3_8_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.JAA.0000873792.00538.78"},{"key":"e_1_3_8_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2024.04.019"},{"key":"e_1_3_8_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/tid.12201"},{"key":"e_1_3_8_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-018-3378-0"},{"key":"e_1_3_8_6_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-016-0964-1"},{"key":"e_1_3_8_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofx140"},{"issue":"1","key":"e_1_3_8_8_2","first-page":"78","article-title":"Advances in pathogen diagnosis of respiratory infection diseases in 2021","volume":"45","author":"Zou XH","year":"2022","unstructured":"Zou XH, Cao B. Advances in pathogen diagnosis of respiratory infection diseases in 2021. Chin J Tuberc Respir Dis 2022; 45(1): 78\u201382. https:\/\/doi.org\/10.3760\/cma.j.cn112147-20211116-00809","journal-title":"Chin J Tuberc Respir Dis"},{"issue":"10","key":"e_1_3_8_9_2","first-page":"920","article-title":"Guidelines for the management of community-acquired pneumonia in children (2024 revision)","volume":"62","author":"The Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical AssociationEditorial Board, Chinese Journal of PediatricsChina Medicine Education Association Committee on Pediatrics","year":"2024","unstructured":"The Subspecialty Group of Respiratory, the Society of Pediatrics, Chinese Medical AssociationEditorial Board, Chinese Journal of PediatricsChina Medicine Education Association Committee on Pediatrics. Guidelines for the management of community-acquired pneumonia in children (2024 revision). Chinese Journal of Pediatrics 2024; 62(10): 920\u2013930. https:\/\/doi.org\/10.3760\/cma.j.cn112140-20240728-00523","journal-title":"Chinese Journal of Pediatrics"},{"key":"e_1_3_8_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40121-022-00635-7"},{"issue":"10","key":"e_1_3_8_11_2","first-page":"1541","article-title":"The CARE guidelines: consensus-based clinical case reporting guideline development","volume":"53","author":"Gagnier JJ","year":"2013","unstructured":"Gagnier JJ, Kienle G, Altman DG, et al. The CARE guidelines: consensus-based clinical case reporting guideline development. 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