{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T13:19:24Z","timestamp":1778159964560,"version":"3.51.4"},"reference-count":6,"publisher":"SMC Media","issue":"5","license":[{"start":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T00:00:00Z","timestamp":1776643200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction:\u00a0Legionella micdadei\u00a0is an uncommon cause of atypical pneumonia and may be underrecognized because routine diagnostic testing primarily identifies\u00a0Legionella pneumophila. Clinical and radiologic manifestations are variable and, in rare instances, may mimic miliary tuberculosis, creating significant diagnostic uncertainty and potential delays in appropriate therapy. Case description:\u00a0A 77-year-old male presented with persistent headache, fatigue, decreased appetite, and unintentional weight loss following several weeks of flu-like symptoms after recent travel to Pakistan. Imaging demonstrated innumerable diffuse pulmonary micronodules concerning for miliary tuberculosis. The patient was placed in airborne isolation and empirically treated with anti-tuberculous therapy. Extensive microbiologic testing, including sputum studies and serologic evaluation, was negative. Because sputum samples could not be obtained, bronchoscopy with bronchoalveolar lavage (BAL) was performed. Molecular testing of BAL fluid identified\u00a0L. micdadei. Anti-tuberculous therapy was discontinued and treatment with levofloxacin was initiated, resulting in rapid clinical improvement. Conclusion:\u00a0This case highlights a rare presentation of\u00a0L. micdadei\u00a0pneumonia with diffuse pulmonary micronodules mimicking miliary tuberculosis. Recognition of this atypical presentation and the use of advanced diagnostic techniques such as bronchoscopy and molecular testing are essential for establishing the correct diagnosis and guiding appropriate management.<\/jats:p>","DOI":"10.12890\/2026_006534","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T13:30:47Z","timestamp":1776691847000},"source":"Crossref","is-referenced-by-count":0,"title":["Legionella micdadei pneumonia mimicking miliary tuberculosis in an elderly traveller: a diagnostic challenge"],"prefix":"10.12890","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9643-4165","authenticated-orcid":false,"given":"Susheel","family":"Joshi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Covenant Healthcare, Saginaw, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4511-3546","authenticated-orcid":false,"given":"Mahima","family":"Upadhyay","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Hurley Medical Center, Flint, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bibhush","family":"Shrestha","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Shaoxing People\u2019s Hospital, Shaoxing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"10.12890\/2026_006534_ref1","doi-asserted-by":"crossref","unstructured":"Lachant D, Prasad P. Legionella micdadei: a forgotten etiology of growing cavitary nodules. Case Rep Pulmonol 2015;2015:535012. doi: 10.1155\/2015\/535012","DOI":"10.1155\/2015\/535012"},{"key":"10.12890\/2026_006534_ref2","doi-asserted-by":"crossref","unstructured":"Cluroe AD. Legionnaire\u2019s disease mimicking pulmonary miliary tuberculosis in the immunocompromised. Histopathology 1993;23:273\u2013276. doi: 10.1111\/j.1365-2559.1993.tb00073.x","DOI":"10.1111\/j.1365-2559.1993.tb00073.x"},{"key":"10.12890\/2026_006534_ref3","doi-asserted-by":"crossref","unstructured":"Dowling JN, Kroboth FJ, Karpf M, Yee RB. Pneumonia and multiple lung abscesses caused by dual infection with Legionella micdadei and Legionella pneumophila. Am Rev Respir Dis 1983;127:121\u2013125. doi: 10.1164\/arrd.1983.127.1.121","DOI":"10.1164\/arrd.1983.127.1.121"},{"key":"10.12890\/2026_006534_ref4","doi-asserted-by":"crossref","unstructured":"McLoud TC, Boiselle PM. Pulmonary infections in the normal host. Radiol Clin North Am 2020;58:1\u201315. doi: 10.1016\/j.rcl.2019.09.001","DOI":"10.1016\/j.rcl.2019.09.001"},{"key":"10.12890\/2026_006534_ref5","doi-asserted-by":"crossref","unstructured":"Bentz JS, Carroll KC, Ward JH, Elstad MR. Acid-fast-positive Legionella pneumophila: a possible pitfall in the cytologic diagnosis of mycobacterial infection in pulmonary specimens. Diagn Cytopathol 2000;22:45\u201348. doi: 10.1002\/(SICI)1097-0339(200001)22:1<45::AID-DC12>3.0.CO;2-Y","DOI":"10.1002\/(SICI)1097-0339(200001)22:1<45::AID-DC12>3.0.CO;2-Y"},{"key":"10.12890\/2026_006534_ref6","doi-asserted-by":"crossref","unstructured":"Kradin RL. Pulmonary infection. In: Kradin RL, editor. Understanding pulmonary pathology. Philadelphia: Elsevier; 2016. p.157\u2013184.","DOI":"10.1016\/B978-0-12-801304-5.00009-5"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6534\/5482","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6534\/5483","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/6534\/5483","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T12:58:49Z","timestamp":1778158729000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/6534"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,20]]},"references-count":6,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.12890\/2026_006534","relation":{"has-manifestation":[{"id-type":"other","id":"1-167-6534-g5482","asserted-by":"subject"},{"id-type":"other","id":"1-167-6534-g5483","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-167","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,20]]}}}