Key message
The sputum colour in patients with severe pneumonia needs to be considered during diagnosis.
Keywords: emergency department, extracorporeal membrane oxygenation, legionella pneumophila pneumonia, orange sputum, urine
We present a case of severe pneumonia with bright orange sputum. Legionella pneumophila pneumonia was diagnosed.
CLINICAL IMAGE
A 72‐year‐old Japanese man with diabetes mellitus visited the emergency department with a persistent high fever, regular heart rate (72 bpm), increased respiratory rate (28/min), and low oxygen saturation (78% in room air). Left chest auscultation revealed inspiratory coarse crackles. Blood tests revealed liver dysfunction. Chest x‐ray exhibited infiltrative shadows in the bilateral lungs (Figure 1A). Chest computed tomography showed extensive ground‐glass opacity and consolidation (Figure 1B). Intubation and ventilator management were initiated. Aspirated airway secretions were bright golden orange (Figure 1C). Sputum analysis, including BIOFIRE® Respiratory 2.1 panel, detected Legionella DNA, and urine was positive for Legionella antigen; Legionella pneumophila pneumonia was diagnosed. Such orange secretions may be produced by L. pneumophila by utilizing tyrosine in the epithelial lining fluid. 1 , 2 Despite levofloxacin treatment, respiratory failure progressed, necessitating transfer to a higher tertiary care level for extracorporeal membrane oxygenation (ECMO). ECMO, with prone therapy, steroids, and antibiotics, was initiated. Two weeks later he was tracheotomized and is undergoing rehabilitation with ventilator support. Sputum colour in pneumonia patients should be considered during diagnosis.
FIGURE 1.
(A) Chest x‐ray shows extensive infiltrative shadows in the bilateral lungs. (B) Chest computed tomography shows extensive ground‐glass opacity and consolidation. (C) Bright orange, very watery airway secretions aspirated using a suction tube.
AUTHOR CONTRIBUTIONS
Toshiyuki Sumi conceived the idea for the manuscript and drafted it. Keito Suzuki, Yuta Koshino, Takumi Ikeda and Yuichi Yamada contributed to the clinical management of the patient. Hirofumi Chiba revised the manuscript for intellectual content. All authors contributed to and approved the final version of the manuscript.
CONFLICT OF INTEREST STATEMENT
None declared.
ETHICS STATEMENT
The authors declare that appropriate written informed consent was obtained for the publication of this manuscript and accompanying images. Consent was obtained from the patient for reporting this case.
ACKNOWLEDGMENTS
The authors thank Editage (www.editage.jp) for English language editing.
Sumi T, Suzuki K, Koshino Y, Ikeda T, Yamada Y, Chiba H. Sputum colour: An indicator of Legionella pneumophila pneumonia. Respirology Case Reports. 2024;12(3):e01312. 10.1002/rcr2.1312
Associate Editor: Belinda Miller
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are available from the corresponding author upon reasonable request.
REFERENCES
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.