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Case Report
Severe Legionnaires’ disease with false negative urine antigen test complicated by myocarditis and cardiac arrest
1 MD, Medical Resident, Internal Medicine Department, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
2 MD, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
3 MD, Director of Infectious Diseases Department, Jamaica Hospital Medical Center, Richmond Hill, NY, USA
Address correspondence to:
Hind El Soufi
MD, 8900 Van Wyck Expwy, Richmond Hill, NY 11418,
USA
Message to Corresponding Author
Article ID: 100009Z16HS2021
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How to cite this article
El Soufi H, El Soufi Y, Mekaiel A, Aneeb M, Bagheri F. Severe Legionnaires’ disease with false negative urine antigen test complicated by myocarditis and cardiac arrest. J Case Rep Images Infect Dis 2021;4:100009Z16HS2021.ABSTRACT
Introduction: Legionnaires’ disease is defined as severe pneumonia with multi-organ failure caused by Legionella species. Urine antigen test is the most common method used for its diagnosis with a sensitivity reaching 80%. False negative test can be suspected when urine samples used are diluted, when they are obtained later than seven days after the onset of pneumonia, when infection is caused by Legionella non-serogroup 1, and when samples contain excessive antigens relative to antibodies, which prevents antibody-to-antigen crosslinking, phenomenon known as post-zone effect. We report a case of pneumonia with multi-organ damage caused by Legionella pneumophila with initial false negative urine antigen test complicated by myocarditis, cardiomyopathy, and cardiac arrest.
Case Report: A 34-year-old healthy male with recent visit to the Caribbean islands presented with fever, cough, and alteration of mental status. Chest X ray showed consolidation in his right upper lung lobe. Legionella urine antigen test was initially negative. High suspicion for Legionnaire’s disease required repeating the test which subsequently came back positive.
Conclusion: High suspicion for the infection prompts repeating or even using a combination of tests to increase sensitivity and to detect all possible species causing the infection.
Keywords: Legionnaires’ disease, Myocarditis, Urine antigen
SUPPORTING INFORMATION
Author Contributions
Hind El Soufi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Yahya El Soufi - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Andrew Mekaiel - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mohammad Aneeb - Substantial contributions to conception and design, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Farshad Bagheri - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Hind El Soufi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
