Clinical Case of the Month: A 64 Year-Old Woman Presenting With Fever, Confusion, Ophthalmoplegia and Pneumonia.

Legionella pneumophila is a major cause of atypical community-acquired pneumonia, which is commonly severe enough to require hospitalization. Though primarily a respiratory infection, Legionellosis involves the central nervous system (CNS) in up to 50% of patients, and diagnosis can be obscured by the absence of obvious respiratory symptomatology. A reversible diffuse encephalopathy is the most common neurologic complication, but focal CNS involvement can sometimes be the initial presentation. We report a case of a woman infected with Legionella pneumophila presenting with vague symptomatology and focal neurologic findings. This report highlights the challenges of early recognition of Legionella infection when neurologic symptoms predominate.