key: cord-0937072-sny4e1wg
authors: Cordas dos Santos, David Manuel; Fischer, Laura; von Bergwelt-Baildon, Michael; Khatamzas, Elham
title: Unexpected community-acquired co-infections during an ongoing pandemic: (one) too many diagnoses at once
date: 2021-07-03
journal: Infection
DOI: 10.1007/s15010-021-01647-0
sha: e7f15ffa97763f0b64e56a034ec327769cdbf744
doc_id: 937072
cord_uid: sny4e1wg

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support. CT chest images showed dramatic progression of pulmonary changes (Fig. 2) . In repeat microbiological investigations, surprisingly Legionella pneumophila was detected in urine and endotracheal secretions by antigen and PCR, respectively, suggestive of previously undiagnosed community-acquired Legionellosis. Due to absence of pulmonary symptoms, respiratory specimens had not been collected on admission. Legionella testing of water systems within our unit was negative. Local health protection agency was notified but investigations could not identify sources for either of two pathogens. Despite maximal treatment including escalation of antimicrobial regimen to meropenem and moxifloxacin on day 5, the patient's condition deteriorated further [1, 2] . Life-extending measures were terminated on day 9.

Polymicrobial life-threatening infections are a known feared complication of hematological malignancies particularly during active immunosuppressive treatment [3] [4] [5] . However, the unique combination of community-acquired infections in this case, highlights the importance of environmental, behavioral and socio-economic risk factors as well as continued re-evaluation of differential diagnosis and therapy in managing these complex cases. Funding Open Access funding enabled and organized by Projekt DEAL. Not applicable.

Code availability Not applicable.

Conflict of interest DCDS, LF, MB and EK do not report any COI with the publication of this case.

Consent to participate Verbal consent was obtained.

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