Legionnaires' disease on azithromycin leading to lofty liver levels

Legionnaires' disease is a serious, life-threatening pneumonia caused by the bacterium <i>Legionella pneumophila</i>. <i>Legionella</i> is a gram-negative bacillus transmitted via inhalation of water droplets, usually from air conditioners or hot tubs. Unlike many respiratory pathogens, <i>Legionella</i> does not spread from person to person. This bacterium primarily affects the pulmonary system, causing atypical community-acquired pneumonia often associated with gastrointestinal symptoms such as diarrhea. In rare cases, <i>Legionella</i> can involve the liver, leading to acute hepatitis. Fluoroquinolones and macrolides are the most effective and commonly used antibiotics for treating Legionnaires' disease. However, both antibiotic classes carry a potential risk of hepatotoxicity, which can result in elevated liver enzymes. Additionally, <i>Legionella</i>-induced liver injury may increase susceptibility to DILI. Here, we present a case of Legionnaires' disease treated with azithromycin, complicated by elevated liver enzymes, highlighting the need for careful monitoring of liver function during treatment.