{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:38:56Z","timestamp":1773337136670,"version":"3.50.1"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>\n                    <jats:italic>Legionella pneumophila<\/jats:italic>\n                    is an uncommon but potentially life-threatening cause of pneumonia in solid organ transplant (SOT) recipients. Diagnosis is challenging due to nonspecific features and the limited sensitivity of conventional assays. Metagenomic next-generation sequencing (mNGS) offers unbiased detection and may be particularly valuable in immunocompromised hosts with refractory pneumonia. We report the first documented case in Asia of cavitary Legionella pneumonia in a kidney transplant recipient. A 60-year-old man presented with fever and bilateral pulmonary nodules 5\u202fmonths post-transplant. Despite empirical antifungal and antibacterial therapy, his condition progressed radiologically to cavitary disease. Bronchoalveolar lavage fluid mNGS identified abundant\n                    <jats:italic>L. pneumophila<\/jats:italic>\n                    reads, confirming the diagnosis. Initial azithromycin monotherapy achieved transient improvement but failed to prevent radiological progression. Escalation to prolonged dual therapy with azithromycin and levofloxacin resulted in rapid symptomatic relief, progressive cavity regression on serial computed tomography, and preserved allograft function. Sequential blood-based mNGS demonstrated declining pathogen reads paralleling recovery. This brief research report emphasizes three practice points for SOT recipients with refractory pneumonia: (1) early mNGS can shorten time-to-diagnosis when routine tests are inconclusive; (2) Legionella infection may manifest with atypical cavitary lesions in immunocompromised hosts, warranting scheduled imaging even when symptoms improve; and (3) prolonged macrolide\u2013fluoroquinolone combination therapy may be required for severe or non-resolving cases. Together with our literature review, this case expands understanding of the radiological spectrum, diagnostic strategies, and therapeutic considerations of Legionella pneumonia in transplant populations.\n                  <\/jats:p>","DOI":"10.3389\/fmed.2026.1697062","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:46:40Z","timestamp":1773298000000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Cavitary Legionella pneumophila pneumonia in a kidney transplant recipient: mNGS-guided diagnosis and prolonged combination therapy"],"prefix":"10.3389","volume":"13","author":[{"given":"Junhong","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feilong","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huaizhou","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiang","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junjun","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liusheng","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Organ Transplantation, 924th Hospital of the Chinese People\u2019s Liberation Army Joint Logistic Support Force","place":["Guilin, Guangxi, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1458276","DOI":"10.3389\/fcimb.2024.1458276","article-title":"Insights into the role of Legionella effectors on host metabolic reprogramming","volume":"14","author":"Wang","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1190631","DOI":"10.3389\/fcimb.2023.1190631","article-title":"Stagnation arising through intermittent usage is associated with increased Legionella exposure risk in hospital water 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A systematic review and meta-analysis","volume":"72","author":"Jasper","year":"2021","journal-title":"Clin Infect Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1016\/j.ijid.2024.02.008","article-title":"Analysis of the effectiveness of combination antimicrobial therapy with quinolones and macrolides for legionnaires\u2019 disease","volume":"145","author":"Kutsuna","year":"2024","journal-title":"Int J Infect Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1380312","DOI":"10.3389\/fcimb.2024.1380312","article-title":"Efficacy of omadacycline in the treatment of Legionella pneumonia after failure of moxifloxacin","volume":"14","author":"Wang","year":"2024","journal-title":"Front Cell Infect Microbiol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.15585\/mmwr.mm7237a1","article-title":"Suspected Legionella transmission from a single donor to two lung transplant recipients\u2014Pennsylvania, May 2022","volume":"72","author":"McGinnis","year":"2023","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1016\/j.ajt.2023.10.009","article-title":"Suspected Legionella transmission from a single donor to two lung transplant recipients\u2014Pennsylvania, May 2022","volume":"23","author":"McGinnis","year":"2023","journal-title":"Am J Transplant"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1697062\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:46:46Z","timestamp":1773298006000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1697062\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":15,"alternative-id":["10.3389\/fmed.2026.1697062"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1697062","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]},"article-number":"1697062"}}