Abstract
A 53-year-old man with alcoholism and a three-day history of diarrhea and abdominal pain was hospitalized with mild acute kidney injury (AKI) and rhabdomyolysis after a fall where he was down for a short duration. Subsequent testing revealed patchy right lower lobe infiltrates on chest X-ray and a positive urinary Legionella antigen test. Creatinine phosphokinase (CPK) peaked at 85,780 U/L (normal 0-250) on hospital day two and remained markedly elevated for five days despite aggressive intravenous (IV) hydration and appropriate antibiotic treatment. When the patient defervesced and showed clinical signs of resolution of pneumonia, the CPK level declined rapidly, and renal function returned to baseline. Rhabdomyolysis with AKI is a rare but serious complication of Legionella pneumonia, with most patients requiring dialysis. Our patient’s complete recovery without renal replacement therapy can probably be attributed to his normal baseline renal function, timely diagnosis of his Legionella-associated rhabdomyolysis, and prompt treatment with aggressive IV hydration and appropriate antibiotics. Legionella infection should be considered in acutely ill patients with rhabdomyolysis of unclear etiology.
Highlights
Legionella pneumophila infection can present in the context of an acute febrile illness (Pontiac fever), or pneumonia (Legionnaires' disease)
Findings associated with Legionnaires' disease include gastrointestinal (GI) symptoms, hyponatremia, transaminitis, high fever, and neurological signs such as headache and confusion
We report the case of a man with Legionnaires' disease who, with quick diagnosis and prompt administration of high volume intravenous (IV) fluids and appropriate antibiotics, avoided severe kidney injury despite significant elevation in creatinine phosphokinase (CPK)
Summary
Legionella pneumophila infection can present in the context of an acute febrile illness (Pontiac fever), or pneumonia (Legionnaires' disease). On hospital day three, the Legionella urinary antigen returned positive (sputum cultures were ordered and eventually tested positive, polymerase chain reaction (PCR) was not ordered), and the patient was switched to azithromycin monotherapy. On day five he defervesced, and on day six the CPK dropped dramatically to 13,125 U/L, and continued to decline steadily. Urine, and stool cultures and a Clostridium difficile PCR were all negative; the diarrhea resolved, and his hemodynamic and respiratory status remained stable throughout the hospitalization He was discharged on hospital day nine after completing a six-day course of azithromycin
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