School of Medicine and Health Sciences Poster Presentations

Title

Legionnaire's Disease Presenting with Severe Rhabdomyolysis and Acute Renal Failure: A Case Report

Poster Number

191

Document Type

Poster

Status

Medical Resident

Abstract Category

Clinical Specialties

Keywords

Legionella, Acute Kidney Injury, Rhabdomyolysis

Publication Date

Spring 2018

Abstract

Legionnaire's disease is caused by Legionella species, and is a recognized but rare cause of rhabdomyolysis. Legionella species live in water, and exposure to inoculated water systems leads to transmission of the disease, and commonly causes pneumonia in infected individuals. While the mechanism of muscle destruction legionella infection causes is not fully understood, the prevailing theory is that rhabdomyolysis is linked to an endotoxin released by the bacteria into the blood stream. Massive muscle necrosis manifests as limb weakness, muscle pain, swelling, and gross pigmenturia due to the release of electrolytes, myoglobin, and other sarcoplasmic proteins into the bloodstream. A common complication of this is acute kidney injury due to myoglobin obstruction of renal tubules and direct glomerular cytotoxicity. We present a case of a 49 year old woman presenting a week following heavy rainfall in the mid-Atlantic region with lower extremity weakness, calf and thigh pain, cough and shortness of breath, subsequently found to have severe rhabdomyolysis and acute kidney injury. Her initial laboratory values showed creatinine kinase levels elevated to 423,920 U/L, acute renal failure (Creatinine 8.9 mg/dL, BUN 60 mg/dL), transaminitis (AST 1,798 U/L, ALT 440 U/L), and hyponatremia (Na 128 mmol/L). Initial chest x-ray was notable for a right lower lobe hazy consolidation, and urine legionella antigen was positive. Subsequent work up including hepatitis, HIV, urine toxicology, thyroid stimulating hormone, nasal PCR and flu swabs, and blood and urine cultures were all negative. The patient was started on levofloxacin and aggressive intravenous fluid hydration. Our case highlights the value of including a broad infectious work up when investigating the cause of rhabdomyolysis, as early diagnosis and initiation of treatment can prevent life threatening complications of the disease. We also review the epidemiology, clinical and laboratory findings, and treatment of Legionnaire’s disease causing rhabdomyolysis.

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Legionnaire's Disease Presenting with Severe Rhabdomyolysis and Acute Renal Failure: A Case Report

Legionnaire's disease is caused by Legionella species, and is a recognized but rare cause of rhabdomyolysis. Legionella species live in water, and exposure to inoculated water systems leads to transmission of the disease, and commonly causes pneumonia in infected individuals. While the mechanism of muscle destruction legionella infection causes is not fully understood, the prevailing theory is that rhabdomyolysis is linked to an endotoxin released by the bacteria into the blood stream. Massive muscle necrosis manifests as limb weakness, muscle pain, swelling, and gross pigmenturia due to the release of electrolytes, myoglobin, and other sarcoplasmic proteins into the bloodstream. A common complication of this is acute kidney injury due to myoglobin obstruction of renal tubules and direct glomerular cytotoxicity. We present a case of a 49 year old woman presenting a week following heavy rainfall in the mid-Atlantic region with lower extremity weakness, calf and thigh pain, cough and shortness of breath, subsequently found to have severe rhabdomyolysis and acute kidney injury. Her initial laboratory values showed creatinine kinase levels elevated to 423,920 U/L, acute renal failure (Creatinine 8.9 mg/dL, BUN 60 mg/dL), transaminitis (AST 1,798 U/L, ALT 440 U/L), and hyponatremia (Na 128 mmol/L). Initial chest x-ray was notable for a right lower lobe hazy consolidation, and urine legionella antigen was positive. Subsequent work up including hepatitis, HIV, urine toxicology, thyroid stimulating hormone, nasal PCR and flu swabs, and blood and urine cultures were all negative. The patient was started on levofloxacin and aggressive intravenous fluid hydration. Our case highlights the value of including a broad infectious work up when investigating the cause of rhabdomyolysis, as early diagnosis and initiation of treatment can prevent life threatening complications of the disease. We also review the epidemiology, clinical and laboratory findings, and treatment of Legionnaire’s disease causing rhabdomyolysis.