Chest Infections |

Legionella: A Rare Cause of Refractory Rhabdomyolysis FREE TO VIEW

Sandeep Chennadi, MD; Sikander Zulqarnain, MD
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Chest. 2015;148(4_MeetingAbstracts):87A. doi:10.1378/chest.2273436
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SESSION TITLE: Chest Infections Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: We report a case of Legionella pneumonia presenting as rhabdomyolysis leading to acute renal failure requiring hemodialysis without any respiratory complaints.

CASE PRESENTATION: 49 year old African-American gentleman with no previous history presented with fevers, weakness and nausea for a week. Review of systems was negative for respiratory or any other complaints. His vitals at presentation were stable and physical examination was unremarkable. Initial laboratory values showed elevated creatinine kinase (127,960 U/L), acute renal failure (BUN:127 mg/dL; creatinine:11.52 mg/dL), hyperkalemia (7.4 mmol/L), hyperphosphatemia (13.9 mg/dL), transaminitis (AST:1366 U/L; ALT:384 U/L) and leukocytosis (19.3 K/µL). Patient underwent emergent hemodialysis. Initial chest x-ray was negative for acute lobar pneumonia. With renal replacement therapy, patient’s creatinine, liver enzymes, leukocytosis and creatinine kinase improved transiently but trended up again. Despite dialysis creatinine kinase level peaked to 303,580 U/L. Further work up including Hepatitis panel, HIV, troponin level, urine toxicology, multiple blood cultures, Influenza swab and virus culture of nasal secretions were all negative. To rule out occult abscess(es) causing muscular destruction, CT scan of chest, abdomen and pelvis were performed and revealed patchy consolidation in right upper lobe of lung. Patient tested positive for urine Legionella antigen. Patient was started on Levofloxacin with subsequent resolution of pneumonia, rhabdomyolysis, renal failure and transaminitis by the time of discharge.

DISCUSSION: Legionella is a rare cause of rhabdomyolysis, with about 30 cases reported in literature. The usual presentation is pneumonia complicated with rhabdomyolysis with or without renal failure. Our case is did not have any respiratory signs and symptoms. Only one such case has previously been reported in literature. This case signifies the importance of working up persistent rhabdomyolysis to exclude infectious etiologies.

CONCLUSIONS: Infectious etiologies particularly Legionella should be an important consideration in evaluation of rhabdomyolysis that fails to resolve despite hemodialysis.

Reference #1: Singh U, Scheld WM. Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis. 1996;22(4):642-9.

Reference #2: Erdogan H, Yilmaz A, Kal O, Erdogan A, Arslan H. Rhabdomyolysis-induced acute renal failure associated with legionnaires' disease. Scand J Urol Nephrol. 2006;40(4):345-6.

DISCLOSURE: The following authors have nothing to disclose: Sandeep Chennadi, Sikander Zulqarnain

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