Legionella pneumonia with severe rhabdomyolysis

Shahzad, Muhamamd A; Fitzgerald, Samuel P; Kanhere, M. H.

doi:10.5694/mja15.00611

Cited by 3 publications

(2 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…AKI due to Legionnaires’ disease is caused by rhabdomyolysis, the direct nephrotoxicity of Legionella bacteria, inflammatory cytokines, and decreased renal blood flow due to hypotension [ 9 ]. There have been many case reports on Legionella, rhabdomyolysis, and renal failure [ 10 – 12 ], and the complication rate of AKI due to Legionnaires’ disease is 13% to 15%, with a mortality rate of 40% to 53% [ 2 , 13 ]. Additionally, 33% to 50% of patients who have Legionnaires’ disease complicated with rhabdomyolysis have AKI [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Fatal Fulminant Legionnaires’ Disease Complicated with Rhabdomyolysis, Acute Kidney Injury, and Non-Occlusive Mesenteric Ischemia: An Autopsy Case Report

et al. 2023

View full text Add to dashboard Cite

Patient: Male, 72-year-old Final Diagnosis: Acute kidney injury • Legionnaires’ disease • nonocclusive mesenteric ischemia • rhabdomyolysis Symptoms: — Clinical Procedure: — Specialty: Gastroenterology and Hepatology • Infectious Diseases • Nephrology Objective: Unusual clinical course Background: Legionnaires’ disease is one of the most common types of community-acquired pneumonia. It can cause acute kidney injury and also occasionally become severe enough to require continuous renal replacement therapy (CRRT). Non-occlusive mesenteric ischemia (NOMI) is a condition characterized by ischemia and necrosis of the intestinal tract without organic obstruction of the mesenteric vessels and is known to have a high mortality rate. Case Report: A 72-year-old man with fatigue and dyspnea was diagnosed with Legionnaires’ disease after a positive result in the Legionella urinary antigen test pneumonia confirmed by chest radiography and computed tomography. He developed acute kidney injury, with anuria, rhabdomyolysis, septic shock, respiratory failure, and metabolic acidosis. We initiated treatment with antibiotics, catecholamines, mechanical ventilation, CRRT, steroid therapy, and endotoxin absorption therapy in the Intensive Care Unit. Despite ongoing CRRT, metabolic acidosis did not improve. The patient was unresponsive to treatment and died 5 days after admission. The autopsy revealed myoglobin nephropathy, multiple organ failure, and NOMI. Conclusions: We report a fatal case of Legionnaires’ disease complicated by rhabdomyolysis, acute kidney injury, myoglobin cast nephropathy, and NOMI. Legionella pneumonia complicated by acute kidney injury is associated with a high mortality rate. In the present case, this may have been further exacerbated by the complication of NOMI. In our clinical practice, CRRT is a treatment option for septic shock complicated by acute kidney injury. Thus, it is crucial to suspect the presence of NOMI when persistent metabolic acidosis is observed, despite continuous CRRT treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Fatal Fulminant Legionnaires’ Disease Complicated with Rhabdomyolysis, Acute Kidney Injury, and Non-Occlusive Mesenteric Ischemia: An Autopsy Case Report

et al. 2023

View full text Add to dashboard Cite

show abstract

“…After being admitted into the ICU, our patient suffered from acute renal failure due to rhabdomyolysis. While over the last 10 years, there have been few reports of rhabdomyolysis occurring as a result of having Legionnaires’ disease,10–16 the mechanism of action is still unclear. There are theories that include the direct invasion of the bacteria into the muscle,17 much like the influenza virus.…”

Section: Discussionmentioning

confidence: 99%

Legionellapneumonia complicated by rhabdomyolysis

2019

View full text Add to dashboard Cite

Legionnaires’ disease is a recognised but rare cause of rhabdomyolysis. It can be further complicated with renal impairment. In this case report, we describe a previously healthy, semiactive 50-year-old man who within days was reduced to having periods of dyspnea after minutes of walking in addition to near fatal acute renal failure. He was found to have the rare triad of Legionella pneumonia, renal failure and rhabdomyolysis, which is associated with high morbidity and mortality. He was treated according to guidelines with azithromycin monotherapy and aggressive fluid hydration. 20 days after admission, the patient was walking independently and discharged home.

show abstract