Concurrent infection with Legionella pneumophila and Pneumocystis carinii in a patient with adult T cell leukemia

A 48-year-old woman was admitted to our hospital with high fever, chills, c ough, and exertional dyspnea. On admission, the chest roentgenogram and com puted tomography scan showed bilateral alveolar infiltration in the middle and lower lung fields. Microscopic examination of the bronchial lavage flui d showed flower cells typical for adult T-cell leukemia (ATL) and cysts of Pneumocystis carinii, and Legionella pneumophila serogroup 1 grew on buffer ed charcoal yeast extract (BCYE)-alpha agar. The patient was successfully t reated with antibiotics including trimethoprim/ sulfamethoxazole, erythromy cin, and sparfloxacin. Remission of ATL was achieved after three courses of antileukemic chemotherapy. Mixed infection of opportunistic pathogens shou ld be considered in patients with ATL.