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April 17, 1981

Rapidly Expanding Pulmonary Nodule Caused by Pittsburgh Pneumonia Agent

Author Affiliations

From the Departments of Internal Medicine (Drs Ellis, Mayers, Martone, Atuk, and Guerrant) and Clinical Pathology (Ms Mitchell), University of Virginia Medical Center, Charlottesville; and the Bureau of Epidemiology, Centers for Disease Control, Atlanta (Dr Martone).

JAMA. 1981;245(15):1558-1559. doi:10.1001/jama.1981.03310400040026

PITTSBURGH pneumonia agent (PPA), also known as TATLOCK and HEBA, and tentatively ascribed to the genus Legionella (L micdadei), has recently been identified as a cause of pneumonia in patients receiving high-dose steroid therapy for rejection of renal transplants.1-4 We report a case of a rapidly expanding pulmonary nodule caused by PPA in an immunosuppressed renal transplant patient.

Report of a Case  A 59-year-old man had a cadaveric renal transplantation because of renal failure caused by familial polycystic kidney disease. After transplantation, he was given prednisone, 2 mg/kg/day, and azathioprine, 3 mg/kg/day. During the next six weeks of hospitalization, he had four episodes of acute graft rejection, each treated with methylprednisolone sodium succinate pulse therapy, 30 to 90 mg/kg/day for three days. He was discharged from the hospital with instructions to take prednisone, 70 mg/day, and azathioprine, 50 mg/day, but was readmitted one week later for a rising serum