Persistently positive culture results in a patient with community-acquiredpneumonia due to Legionella pneumophila

We describe a patient with community-acquired pneumonia due to Legionella p neumophila serogroup 6. This patient was found to have bronchoalveolar carc inoma of the lung by means of cytologic testing in 1 of 2 bronchoalveolar l avage samples, but no lesions were visible on bronchoscopy. Despite intrave nous administration of azithromycin to the patient, repeat culture and poly merase chain reaction showed persistence of Legionella; the isolates remain ed susceptible to azithromycin. The patient did not respond to 14 doses of daily intravenously administered azithromycin. The poor outcome may have be en partially due to the suspected underlying lung malignancy, as shown by c ytologic examination, and by a delay in seeking medical attention.