Staphylococcus haemolyticus superinfection of legionella pneumonia during infliximab therapy

We present the case of a 42-year-old man affected by psoriasis with Staphylococcus Haemolyticus superinfection of Legionella pneumonia during infliximab therapy. The introduction of compounds that block TNF-α has yielded great benefits for patients affected by selected autoimmune diseases that fail to respond to classic anti-inflammatory agents, but, on the other hand, has led to an increased susceptibility to infections, in particular of those caused by intracellular pathogens, such as L. Pneumophila. Emerging evidence suggests that legionellosis can be complicated by superinfection with other agents, including saprophytic microorganisms, among which coagulasenegative staphylococci. To our knowledge, this is the first report of systemic legionellosis with superinfection by S. Haemolyticus, an emerging nosocomial multi-resistant pathogen that commonly causes septicemia, osteomyelitis or endocarditis, but has not so far been associated with necrotizing pneumonia. Despite the optimal antimicrobial therapy for Staphylococcus spp. Pneumonia is still controversial, evidence suggests that in patients with confirmed positivity for methicillin resistant strains, particularly if sensitivity to vancomycin is suboptimal, linezolid should be the first choice therapy, being superior to vancomycin and teicoplanin.