Clinical communicationLegionella pneumonia presenting with rhabdomyolysis and acute renal failure: A case report
Introduction
Legionella pneumophila came to attention in 1976 when the CDC identified it as the causative agent in a massive outbreak of pneumonia among attendees of an American Legion convention in Philadelphia. Hence, it was coined Legionnaires’ disease. Legionellae are intracellular gram-negative parasites that flourish naturally in fresh water (32°–45°C) and can replicate within alveolar macrophages, and potentially can be fatal. The incubation period for Legionnaires’ disease is 2–10 days. Many outbreaks have been associated with airborne transmission of Legionella bacteria found in cooling towers, showers, faucets, aerosolizing devices, evaporating condensers, humidifiers, whirlpool baths, medication nebulizers, and even potting soil. However, many cases are sporadic and the source or mode of transmission remains unknown. Also, most cases are not diagnosed or reported (4, 5, 6). Although rare, the associated complication of rhabdomyolysis and acute renal failure has the potential to carry a high morbidity and mortality if not recognized quickly. We present a case of a patient with Legionnaire’s disease and these complications. This report was considered exempt by the Summa Health System IRB.
Section snippets
Case presentation
A 56-year-old white man presented to the Emergency Department (ED) via Emergency Medical Services (EMS). His wife found him on the bathroom floor. She reported that her husband was lethargic and had decreased responsiveness for the last two days as well as a 10-pound weight loss over the last 2–3 weeks. The patient was responsive to questioning and reported copious watery diarrhea six times per day for the last two days, as well as shortness of breath, generalized weakness, and excessive
Epidemiology
At least 46 species and 68 serogroups of Legionella have been identified. Legionellosis (infections caused by the Legionella genus) is prevalent among patients with immuno-suppression, elderly male smokers, chronic lung disease patients, malignancy, renal disease, and recent travel (4, 7). Outbreaks have been recognized throughout North America, Africa, Australia, Europe, and South America (11). Cases have been reported among lung, heart, liver, kidney, and bone marrow transplant recipients,
Conclusion
A case of Legionnaire’s disease complicated by rhabdomyolysis and renal insufficiency is presented. While associated rhabdomyolysis is uncommon, Legionnaires’ disease is a fairly common cause of CAP and nosocomial pneumonia in the US. It should be considered in any ED patient with identifiable risk factors, and symptoms or signs suggestive of Legionella infection. Risk factors include immuno-suppression, elderly male smokers, malignancy, COPD, recent travel, and other underlying illnesses.
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Established association of legionella with rhabdomyolysis and renal failure: A review of the literature
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