Extreme Rhabdomyolysis, Acute Renal Failure, and Protracted Ileus in a Case of Legionella Pneumonia

Abstract

A 53-year-old man developed a Legionella pneumophila pneumonia complicated by rhabdomyolysis, acute kidney injury, and protracted ileus. Risk factors were smoking and chronic alcoholism, but the patient had no history of previous abdominal surgery. Hemodialysis was required for a period of 5 weeks with a full renal recovery. Pneumonia required respiratory support but for a limited period of 6 days. The protracted course of the ileus led to explorative laparotomy despite negative computed tomography findings. No cause of mechanical obstruction was found at surgery and common etiologies of intestinal obstruction were excluded. Parenteral nutrition was needed for a total of 4 weeks, before recovery of intestinal motility. This case illustrates the apparent discrepancy between the pulmonary symptoms and the extrapulmonary manifestations that could be seen as a consequence of an exaggerated immune response.

[Retracted] Application of Laparoscopy Combined with Enhanced Recovery after Surgery (ERAS) in Acute Intestinal Obstruction and Analysis of Prognostic Factors: A Retrospective Cohort Study

“…Some scholars believe that if the surgical intervention is delayed for more than 24 hours, the risk of bowel resection will be greatly augmented, and if the symptoms are not alleviated within 96 hours, the risk will continue to increase [ 10 ]. Therefore, early diagnosis and surgical therapeutic are the key to improve the prognosis of acute intestinal obstruction and reduce complications and mortality [ 11 ]. In this study, a retrospective cohort study was conducted to analyze the effect of stent combined with laparoscopy combined with ERAS in the operation of acute intestinal obstruction and to explore and analyze the prognostic factors.…”

Deadlift-Induced Paraspinal Compartment Syndrome: A Case Report

“…Causes of paraspinal compartment syndrome can also include non-spinal surgery, such as aortic or gastric procedures, direct trauma, vasoconstrictor use, or exercise. Activities such as skiing, rowing, surfboarding, and rugby have been reported as triggering events; however, the most common cause is weightlifting [10,11,12,13]. Thirteen reported cases of paraspinal compartment syndrome in the last decade have involved weightlifting, with the deadlift, as in our case, being the most commonly isolated movement [10,11,12,13].…”

“…In virtually all cases of LPCS, bowel sounds are absent, presumably from paralytic ileus [10][11][12][13][14]. The proposed mechanism for Ileus in rhabdomyolysis is myoglobin cast aggregation impairing small bowel microcirculation [15].…”

Immensely high Creatine Kinase levels in a case of rhabdomyolysis due to Legionnaires’ disease in a patient on tofacitinib: a case report and literature review

“…A PubMed MeSH search with the terms “Legionella”, “rhabdomyolysis”, “renal failure ” and “kidney injury”, yielded 30 published cases. 3 – 6 , 9 – 11 The etiology of rhabdomyolysis is thought to be from an endotoxin or exotoxin release from Legionella pneumophila . 5 There are two theories regarding the etiology of AKI; immune and infection related.…”

“… 7 The risk factors for Legionnaires’ disease include heavy smoking, chronic alcoholism, age >50 years, diabetes, end-stage renal or pulmonary disease, and immunodeficiency. 8 , 9 …”