Seegobin Karan, Maharaj Satish, Baldeo Cherisse, Downes Julio Perez, Reddy Pramod
Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL 32209, USA.
Case Rep Infect Dis. 2017;2017:8051096. doi: 10.1155/2017/8051096. Epub 2017 Oct 4.
To present a case of an uncommon triad of pneumonia, rhabdomyolysis, and renal failure, with review of the relevant literature.
A 51-year-old with a history of human immunodeficiency virus (HIV), chronic obstructive pulmonary disease (COPD), and hypertension presented with fever, cough, and shortness of breath over four days. Chest X-ray showed consolidation in left lower lung field; urine was positive for Legionella antigen and myoglobin; creatine kinase was 51092U/L; creatine was 6.9 mg/dL, and his CD4 count was 41 cells/ul. He was managed with azithromycin and levofloxacin and further required dialysis and ventilatory support in the intensive care unit due to renal failure and respiratory failure. He responded well to the treatment and made a complete recovery. infection is a recognized but rare cause of rhabdomyolysis with high morbidity and mortality when there is extrapulmonary involvement. Early diagnosis and appropriate treatment is essential to improve outcomes.
Physicians should consider pneumonia in patients with rhabdomyolysis, renal failure, and respiratory symptoms. Early diagnosis and treatment have been shown to have good clinical response. Timely intensive care management, together with early and judicious use of dialysis in patients complicated with rhabdomyolysis and renal failure, may lead to good outcomes.
报告一例罕见的肺炎、横纹肌溶解症和肾衰竭三联征病例，并复习相关文献。
一名51岁男性，有人类免疫缺陷病毒（HIV）感染史、慢性阻塞性肺疾病（COPD）和高血压病史，四天来出现发热、咳嗽和呼吸急促。胸部X线显示左下肺野实变；尿液中军团菌抗原和肌红蛋白呈阳性；肌酸激酶为51092U/L；肌酐为6.9mg/dL，其CD4细胞计数为41个/微升。给予阿奇霉素和左氧氟沙星治疗，由于肾衰竭和呼吸衰竭，在重症监护病房进一步需要透析和通气支持。他对治疗反应良好，完全康复。感染是横纹肌溶解症的一种公认但罕见的病因，当有肺外受累时，发病率和死亡率很高。早期诊断和适当治疗对于改善预后至关重要。
医生应考虑在出现横纹肌溶解症、肾衰竭和呼吸道症状的患者中诊断军团菌肺炎。早期诊断和治疗已显示出良好的临床反应。对于合并横纹肌溶解症和肾衰竭的患者，及时的重症监护管理以及早期和明智地使用透析可能会带来良好的预后。
