Objective: Present rare case of ataxia and tremor one year following Legionella infection with CNS symptoms.

Background: Transient, acute neurological syndromes may occur in patients with Legionella pneumonia, usually with full resolution. Cases with tremor or prolonged course of ataxia are rarely described and not well documented.

Methods: Case report and literature review.

Results: A 46-year-old man was referred with a working diagnosis of a psychogenic movement disorder. He was hospitalized one year previous after developing fevers, confusion, and malaise for 5 days. Diagnosis of Legionnaire’s Disease was made by chest CT and positive urine antigen test. He was documented to be lethargic, dysarthric, and ataxic. MRI was read as unremarkable, and LP was not performed. Despite full antibiotic treatment, after discharge he was disabled due to residual gait ataxia, tremors, hip pain, and cognitive and sensory complaints, rendering him unable to return to work as a truck driver or perform many activities of daily living. Old records noted hyponatremia and elevated liver function tests, consistent with Legionella. Despite previous normal report, a reversible diffusion-weighted imaging positive T2/FLAIR splenium hyperintensity was noted, consistent with previous reports of CNS involvement in Legionella infection. Examination showed hypermetric saccades, dysarthric and slow speech, right more than left 1-3Hz tremor with cerebellar and dystonic features, dysmetria in all limbs, broad-based gait, and positive Romberg. Extensive workup for alternative causes was negative. Review of similar cases in recent literature was remarkable for lack of description of tremor and rarity of prolonged symptoms beyond the acute recovery period. Neurologic symptoms occur in 40-50% of Legionnaire’s disease cases, the most common being encephalopathy, dysarthria and ataxia, and rarely focal symptoms. Pathophysiology is unclear without evidence of CNS infection with Legionella.

Conclusions: CNS involvement is common with Legionella pneumonia, and rarely patients can have prolonged neurologic symptoms. Better recognition of this syndrome can lead to more rapid diagnosis and possible identification of treatments.

Submitted for American Academy of Neurology 2016 meeting but no acceptance has been announced.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/prolonged-cerebellar-syndrome-after-legionnaires-disease/