[A case of Legionella pneumonia with diabetic ketoacidosis rescued despite the development of acute renal failure and ARDS].

A 57-year-old man was admitted to our hospital complaining of general fatigue and appetite loss. The initial chest radiograph showed infiltration in the left upper lung field. Cefozopran was administered. Concomitant diabetic ketoacidosis was treated with hydration and rapid-acting insulin. However he was intubated and ventilated because of deteriorated respiratory condition and ketoacidosis on the 3rd hospital day. Urinary legionella antigen was detected the same day, therefore ciprofloxacin and imipenem were initiated. On the 4th hospital day, he developed acute renal failure and was treated with continuous hemodiafiltration. In addition, he developed adult respiratory distress syndrome on the 6th hospital day, therefore siveletat sodium was given. The patient gradually began to improve and was extubated on the 17th hospital day. After that he was transferred to the metabolic ward on the 24th hospital day for control of his diabetes mellitus. Despite the severe complications in his clinical course, including diabetic ketoacidosis, acute renal failure and ARDS, detection of Legionella pneumophila by a urinary antigen test, Gimenez stain and sputum culture made prompt and proper administration of antibiotics possible, finally yielding a desirable outcome.