Legionnaires' Disease with Neurological Manifestations: Case Report

INTRODUCTION. Legionnaires' disease may be manifested by neurological symptoms along with lung damage. Cerebellar ataxia and dysarthria are rare extrapulmonary manifestations of legionellosis. These symptoms significantly reduce the quality of life of patients. AIM. To analyze the literature data on neurological manifestations of legionellosis and to present a clinical case of Legionnaires' disease manifestation with neurological symptoms. MATERIAL AND METHODS. We performed an analysis of the available literature. Twenty-four Russian and international literature sources (PubMed databases) were evaluated, describing the characteristics and prevalence of neurological manifestations in Legionnaires' disease. We also described the main theories of the pathogenesis of these clinical manifestations. Our clinical case is presented. RESULTS AND DISCUSSION. As of today, few cases of Legionnaires' disease with cerebellar symptoms have been described. Dysarthria and ataxia are the most frequent manifestations of cerebellar dysfunction in legionellosis. Cases where neurologic symptoms persisted after the resolution of pneumonia have been described previously. There are also reports of manifestation of Legionnaires' disease with cerebellar ataxia. The pathophysiology of cerebellar involvement is unknown. There are hypotheses of toxin-mediated and immune-mediated mechanisms. Recent studies have shown that L. pneumophila can activate receptors responsible for enacting the inflammasome pathway. This mechanism promotes cell death that occurs to remove the intracellular pathogen, which may be responsible for central nervous system dysfunction. CASE PRESENTATION. A 48-year-old woman was hospitalized with a suspected stroke. She works in diamond production and is in contact with aerosolized liquids. Four days before hospitalization she complained of a headache, and in the evening before she lost consciousness. Slurred speech, unsteadiness, and inability to walk were noted. At hospitalization, no instrumental evidence of stroke was obtained. Inflammatory markers were elevated. Chest computer tomography showed infiltrative changes. The rapid test for antigenuria (L. pneumophila) was positive, and community-acquired legionellosis was confirmed. Levofloxacin was administrated. After discharge, dysarthria, dysphagia, and instability in the Romberg pose persisted. CONCLUSION. The example of this clinical observation demonstrates that in rare cases Legionnaires' disease can manifest as other diseases, which requires a certain vigilance of doctors of different specialities in order to timely diagnose the disease. KEYWORDS: Legionnaires' disease, legionellosis, community-acquired pneumonia, central nervous system, infectious disease