Severe Legionnaires’ Disease Complicated by Rhabdomyolysis and Clinically Resistant to Moxifloxacin in a Splenectomised Patient: Too Much of a Coincidence?

Abstract

We here report a case of Legionnaires' disease in a splenectomised patient, complicated by rhabdomyolysis and acute renal failure and characterized by a poor clinical response to moxifloxacin. Splenectomy is not included among the factors, typically associated with higher risk or mortality in patients with Legionellosis. However, our report is consistent with previous case reports describing severe Legionella infections in asplenic subjects. The possibility that functional or anatomic asplenia may be a factor predisposing to severe clinical course or poor response to therapy in patients with Legionella infection cannot be excluded, deserving further investigation in the future. More studies are required in order to clarify the underlying pathophysiological mechanisms that connect asplenia, immunological response to Legionella, and pathogen's resistance to antibiotics.

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.…”

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

“…In adults, Legionella causes 2–15% of community acquired pneumonia (CAP) cases that require hospitalization [ 5 ]. It is the second most common cause of serious pneumonia that needs admission in an intensive care unit (ICU) [ 5 ].…”

“…In adults, Legionella causes 2–15% of community acquired pneumonia (CAP) cases that require hospitalization [ 5 ]. It is the second most common cause of serious pneumonia that needs admission in an intensive care unit (ICU) [ 5 ]. The first report that associated Legionella and rhabdomyolysis was published in 1980 by Posner et al [ 5 ] It is a recognized but rare cause of rhabdomyolysis [ 1 , 2 ]; a clinical syndrome characterized by elevated serum concentrations of creatine phosphokinase (CPK) and myoglobinuria leading to renal dysfunction [ 17 ].…”

“…However, this is not a rapid test and usually takes 3–5 days [ 1 ]. Urine antigen test is a rapid, practical, and inexpensive method for the diagnosis of the disease, characterized by sensitivities of 70–90% and specificities approaching 100% [ 4 , 5 ]. In our case the use of urine antigen testing confirmed the etiology of the pneumonia.…”

“…Thirteen patients made full recovery, five of which were treated with a quinolone and macrolide, with the others having either a quinolone or macrolide as part of their treatment. Observational studies suggest that quinolones are more likely to achieve a favourable outcome in terms of patient survival and length of hospitalization [ 5 ]. Combined treatment is believed to be superior to monotherapy in cases of severe clinical disease or in immunosuppressed subjects [ 5 ].…”