A RARE CASE OF RHABDOMYOLYSIS AND ANURIC RENAL FAILURE IN A PATIENT WITH LEGIONNAIRES' DISEASE

Abstract

SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Presented is a rare case of rhabdomyolysis and acute anuric renal failure caused by Legionnaires' disease CASE PRESENTATION: A 69 year old male truck driver with well-controlled HTN, HLD, and normal renal function at baseline presented with 3 days of progressive weakness and malaise. On exam, temperature 101.3F, respiratory rate 22, heart rate 122 and SpO2 92% on RA. Labs were remarkable for serum creatinine 5.1, CPK 53,734, and WBC 15K. Chest x-ray showed a right hilar consolidation. He was started on CAP coverage and fluids for rhabdomyolysis. Despite aggressive fluid resuscitation, over the next 48 hours the patient progressed to anuria with a creatinine of 10.1 and had increasing oxygen requirements to 10 L via simple facemask. Legionella urine antigen came back positive, and he had no other obvious causes of rhabdomyolysis. On day 3 he was started on hemodialysis, which resulted in down-trending CPK and decreased oxygen requirement to room air, but his anuria did not improve. He completed 10 days of azithromycin and was discharged on scheduled hemodialysis. DISCUSSION: Rhabdomyolysis and acute renal failure are known but serious complications of Legionella infection. Progression to anuria requiring dialysis is an extremely rare but very significant cause of morbidity in patients with Legionnaires’ disease. Our patient initially presented with no respiratory complaints, quickly developed anuria, and required continued hemodialysis despite resolution of his infection. CONCLUSIONS: Rhabdomyolysis and acute renal failure may be the presenting features of patients with Legionnaires' disease. Reference #1: Stout, J. E. and V. L. Yu (1997). "Legionellosis." N Engl J Med 337(10): 682-687. Reference #2: Soni, A. J. and A. Peter (2019). "Established association of legionella with rhabdomyolysis and renal failure: A review of the literature." Respir Med Case Rep 28: 100962. Reference #3: Fields, B. S., et al. (2002). "Legionella and Legionnaires' disease: 25 years of investigation." Clin Microbiol Rev 15(3): 506-526. DISCLOSURES: No relevant relationships by Alivia Adkins, source=Web Response No relevant relationships by Muthiah Muthiah, source=Web Response No relevant relationships by Robert Rudd, source=Web Response