Legionnaire's disease associated with acute respiratory distress syndrome and acute cerebral oedema

Objective: To report the original observation of a patient with legionella’s pneumopathy complicated with acute respiratory distress syndrome (ARDS) and a concomittant cerebral oedema occurred in the setting of positive end-expiratory pressure, reversible with the weaning of mechanical ventilation. Design and Setting: Case report, Intensive Care Unit, General Hospital. Patient: Young female patient with HIV infection Interventions: Diagnostic fiberoptic bronchoscopy, legionella urinary antigen, lumbar puncture, computed tomography and magnetic resonance imaging of the brain, mechanical ventilation, positive end-expiratory pressure, low tidal volume, permissive hypercapnia, prone position, systemic antibiotherapy. Results: Cerebrospinal fluid polymerase chain reaction was negative for both legionella and herpes virus or any other opportunistic infection. Chest radiographies showed the progressive resolution of ARDS with adapted antibiotherapy. The clinical improvement and total reversibility of cerebral oedema were observed in magnetic resonance imaging of the brain with concomitant weaning of positive end-expiratory pressure and mechanical ventilation. Conclusion: In ARDS, protective ventilatory strategy using low tidal volume ventilation, positive end-expiratory pressure and permissive hypercapnia are recommended to improve intrapulmonary shunt, arterial oxygenation and to decrease mortality, but the incidence of neurological complications as intracranial hypertension is probably underestimated. Further studies to evaluate the neurological impact (hemodynamic and anatomical consequences) of mechanical ventilation in ARDS are necessary.