{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T20:38:54Z","timestamp":1792269534625,"version":"4.4.0"},"reference-count":14,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Investigative Medicine High Impact Case Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Legionella pneumophila<\/jats:italic>\n                    is a well-recognized cause of community-acquired pneumonia, but its capacity to cause extrapulmonary complications, including myocarditis, remains underappreciated. Myocarditis is among the rarest and most serious cardiac manifestations of\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    infection and may be underdiagnosed in critically ill patients, where troponin elevations are often attributed to sepsis-related myocardial injury. We report the case of a 51-year-old woman with diabetes mellitus, ulcerative colitis managed with adalimumab (a tumor necrosis factor-\u03b1 inhibitor), and a significant smoking history who presented to the emergency department after being found unresponsive. She was febrile, tachycardic, and in respiratory distress, with laboratory findings significant for markedly elevated troponin (7,377 ng\/L), creatine kinase (10,561 U\/L), and procalcitonin (27 ng\/mL). Echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of less than 15%. A urine antigen test confirmed\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    pneumonia. Hemodynamic assessment using the Fick method excluded cardiogenic shock, and left heart catheterization demonstrated no obstructive coronary artery disease. Following a 14-day course of levofloxacin along with supportive care, her cardiac function recovered completely, with a follow-up ejection fraction of 71%. This case highlights the potential for\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    infection to cause fulminant yet fully reversible myocarditis and underscores the role of TNF-\u03b1 inhibitor therapy as a predisposing factor for severe\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    disease. Clinicians should maintain a high index of suspicion for myocarditis in patients with\n                    <jats:italic toggle=\"yes\">Legionella<\/jats:italic>\n                    pneumonia who present with unexplained troponin elevation and new systolic dysfunction, as early recognition and targeted antimicrobial therapy can lead to complete cardiac recovery.\n                  <\/jats:p>","DOI":"10.1177\/23247096261490386","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T19:04:26Z","timestamp":1789758266000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["<i>Legionella<\/i>\n                    Myocarditis with Reversible Left Ventricular Dysfunction in a Patient Receiving Adalimumab: A Case Report"],"prefix":"10.1177","volume":"14","author":[{"given":"Alhasan Saleh","family":"Alzubi","sequence":"first","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1170-8118","authenticated-orcid":false,"given":"Mohamed","family":"Shelig","sequence":"additional","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasser","family":"Hegazy","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1092-3565","authenticated-orcid":false,"given":"Zakaria","family":"Alagha","sequence":"additional","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman Farag","family":"Abdelwahed","sequence":"additional","affiliation":[{"name":"East Carolina University Brody School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaden","family":"Daloub","sequence":"additional","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashraf M.","family":"Elghul","sequence":"additional","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amro","family":"Al-Astal","sequence":"additional","affiliation":[{"name":"Marshall University Joan C. Edwards School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"e_1_3_7_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejm197712012972201"},{"key":"e_1_3_7_3_2","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.40529"},{"key":"e_1_3_7_4_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2011.131872"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/18.1.120"},{"key":"e_1_3_7_6_2","first-page":"601","article-title":"Suspected Legionella-induced perimyocarditis in an adult in the absence of pneumonia: a rare clinical entity","volume":"36","author":"Burke PT","year":"2009","unstructured":"Burke PT, Shah R, Thabolingam R, Saba S. Suspected Legionella-induced perimyocarditis in an adult in the absence of pneumonia: a rare clinical entity. Tex Heart Inst J. 2009;36:601-603.","journal-title":"Tex Heart Inst J"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.79.2.232"},{"key":"e_1_3_7_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/508538"},{"key":"e_1_3_7_9_2","unstructured":"U.S. Food and Drug Administration. FDA Drug Safety Communication: Drug labels for the Tumor Necrosis Factor-alpha (TNF\u03b1) blockers now include warnings about infection with Legionella and Listeria bacteria. 2011. accessed March 23 2026."},{"key":"e_1_3_7_10_2","doi-asserted-by":"publisher","DOI":"10.5195\/ijms.2025.4069"},{"key":"e_1_3_7_11_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.3371"},{"key":"e_1_3_7_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.09.074"},{"key":"e_1_3_7_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy077"},{"key":"e_1_3_7_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjco.2022.12.010"},{"key":"e_1_3_7_15_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-024-01252-y"}],"container-title":["Journal of Investigative Medicine High Impact Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096261490386","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23247096261490386","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23247096261490386","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T11:46:16Z","timestamp":1790077576000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23247096261490386"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9]]},"references-count":14,"alternative-id":["10.1177\/23247096261490386"],"URL":"https:\/\/doi.org\/10.1177\/23247096261490386","relation":{},"ISSN":["2324-7096","2324-7096"],"issn-type":[{"value":"2324-7096","type":"print"},{"value":"2324-7096","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9]]},"article-number":"23247096261490386"}}