A 56-year-old male, immunocompromised due to a recent kidney transplant and on immunosuppressants, presented with fever, cough, and shortness of breath, progressing to respiratory failure. Initial bronchoalveolar lavage cultures were negative, but subsequent cultures on buffered charcoal yeast extract (BCYE) agar grew a gram-negative rod, identified as Legionella micdadei by 16S rRNA gene sequencing. The patient was successfully treated with azithromycin and rifampin. This case highlights the importance of considering Legionella species, particularly L. micdadei, in immunocompromised patients with pneumonia, and the utility of specific culture media and molecular diagnostics for identification.
Key note: Legionella micdadei pneumonia in immunocompromised patients requires specific diagnostic approaches beyond routine cultures.