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Treatment of chronic lymphocytic leukaemia (CLL) with nucleoside analogues may cause T cell dysfunction, thereby predisposing to opportunistic infections in addition to bacterial infections as a result of neutropenia and humoral immune dysfunction.1 The following case provides an example of fatal legionella pneumonia arising in these circumstances.
A 62 year old male non-smoker had obtained a good partial response after completing four courses of fludarabine treatment for relapse of stage B CLL. He had been treated at diagnosis 2½12 …