A case of severe cardiogenic shock triggered by Legionella infection treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO).

BACKGROUND

Pneumonia caused by Legionella pneumophila and other Legionella spp. is associated with high hospitalization and mortality rates. We herein report a case of severe cardiogenic shock triggered by Legionella pneumonia that was successfully treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO).

CASE PRESENTATION: A 59-year-old man was admitted to the emergency department with a fever and consciousness disturbance. He was diagnosed with Legionella pneumonia based on urinary antigen test results. Despite receiving supplemental oxygen, the patient's oxygenation worsened, necessitating immediate tracheal intubation. Mechanical ventilation and vasopressor therapy were initiated;however, tachycardia due to atrial fibrillation, along with a reduced ejection fraction of only 15%, led to the development of cardiogenic shock. On day 1 in the intensive care unit (ICU), VA-ECMO and intra-aortic balloon pumping (IABP) were introduced. By day 3, his tachycardia and myocardial dysfunction had improved, leading to the withdrawal of VA-ECMO on day 4. His respiratory function improved and he was extubated on day 7. He was discharged from the ICU on day 9.

CONCLUSIONS

VA-ECMO is a valuable treatment modality for refractory cardiogenic and septic shock. Considering the induction of VA-ECMO as a therapeutic option at an appropriate time is important in such cases. J. Med. Invest. 72 : 434-437, August, 2025.