TREMENDOUS HIGH PLASMA LIPOPOLYSACCHARIDE CONCENTRATIONS IN A PATIENTWITH LEGIONELLA-PNEUMOPHILA PNEUMONIA

We describe a patient suffering from nosocomial Legionella pneumophila pneumonia with extremely high lipopolysaccharide (LPS) concentrations (peak concentration = 725 EU/ml). This unexpectedly high LPS load [ed to an exaggerated response of the cytokine network. Although immediat e treatment with macrolides was instituted, the patient developed an a dult respiratory distress syndrome. Despite application of nitric oxid e and porcine natural surfactant factor, the patient died 5 days after admission to the ICU. Because of this dramatic case, we emphasize phy sicians to be aware of L. pneumophila and to include this organism int o the diagnosis and antibiotic therapy in patients with nosocomial pne umonia.