Legionnaires’ Disease Complicated with Rhabdomyolysis and Acute Kidney Injury in an AIDS Patient

Abstract

Objective To present a case of an uncommon triad of Legionella pneumonia, rhabdomyolysis, and renal failure, with review of the relevant literature. Case A 51-year-old with a history of human immunodeficiency virus (HIV), chronic obstructive pulmonary disease (COPD), and hypertension presented with fever, cough, and shortness of breath over four days. Chest X-ray showed consolidation in left lower lung field; urine was positive for Legionella antigen and myoglobin; creatine kinase was 51092U/L; creatine was 6.9 mg/dL, and his CD4 count was 41 cells/ul. He was managed with azithromycin and levofloxacin and further required dialysis and ventilatory support in the intensive care unit due to renal failure and respiratory failure. He responded well to the treatment and made a complete recovery. Legionella pneumophila infection is a recognized but rare cause of rhabdomyolysis with high morbidity and mortality when there is extrapulmonary involvement. Early diagnosis and appropriate treatment is essential to improve outcomes. Conclusion Physicians should consider Legionella pneumonia in patients with rhabdomyolysis, renal failure, and respiratory symptoms. Early diagnosis and treatment have been shown to have good clinical response. Timely intensive care management, together with early and judicious use of dialysis in patients complicated with rhabdomyolysis and renal failure, may lead to good outcomes.

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

“…The association of Legionella and rhabdomyolysis was first described in 1980 by Posner et al [6]. Since that time, at least 17 additional cases have been reported in the literature [6–22]. Our patient had one of the highest ever reported CK levels [23].…”

“…From the literature, patients presenting with rhabdomyolysis usually require ICU admission due to the associated renal impairment. At least 13/17 patients needed intermittent hemodialysis, and among them 11 made a complete recovery [22]. The etiology of acute kidney injury (AKI) is likely related to acute tubular necrosis or acute tubule-interstitial nephritis [9].…”

Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review

“…Legionella pneumonia accounts for 2–15% of all community-acquired pneumonia (CAP) cases requiring hospitalization. It is the second most common cause of serious pneumonia and requires ICU admission ( 7 ). Legionnaire's disease is a severe form of pneumonia caused by Legionella ; it can have extrapulmonary manifestations ( 8 ).…”

Legionellapneumonia complicated by rhabdomyolysis

“…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.…”