Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
Department of Internal Medicine, Detroit Medical Center Sinai Grace Hospital, Detroit, MI, USA.
Am J Case Rep. 2022 Jun 3;23:e936264. doi: 10.12659/AJCR.936264.
BACKGROUND Legionella infection is a common cause of atypical pneumonia, known as Legionnaires' disease when infection extends to extrapulmonary involvement, which often leads to hospitalization. The triad of Legionella pneumonia, rhabdomyolysis, and renal failure displays a rare yet fatal complication without prompt management. CASE REPORT Our patient was a 62-year-old man with no significant medical history who developed Legionnaires' disease with severely elevated creatinine phosphokinase (CPK) of 9614 mcg/L, consistent with rhabdomyolysis. He experienced severe headache, anorexia, and hematuria, which prompted him to seek medical care. Pertinent social history included recent flooding in his neighborhood, which surrounded the outer perimeter of his home. His clinical manifestations and laboratory findings were consistent with Legionella infection, with concomitant acute kidney injury. A chest X-ray revealed hazy left perihilar opacities concerning for atypical pneumonia. Immediate interventions of hydration and antigen-directed azithromycin were initiated to prevent rapid decompensation. His clinical symptoms resolved without further complications, and he was not transferred to the Intensive Care Unit (ICU). CONCLUSIONS Legionella-induced rhabdomyolysis is an uncommon association that can lead to acute kidney failure and rapid clinical deterioration. Early and aggressive management with fluid repletion and appropriate antibiotics can improve clinical manifestations and hospital length of stay. Our patient's reduction in CPK levels and clinical improvement confirmed that extrapulmonary involvement in Legionella infection can lead to rhabdomyolysis. It is important for healthcare providers to recognize the clinical triad of Legionella pneumonia, rhabdomyolysis, and renal failure as prompt and timely management to reduce associated morbidity.
军团菌感染是一种常见的非典型肺炎病因，当感染扩展到肺外累及时，称为军团病，这通常导致住院治疗。军团菌肺炎、横纹肌溶解和肾衰竭三联征显示出一种罕见但致命的并发症，如果不及时治疗，可能会导致死亡。
我们的患者是一位 62 岁的男性，无明显病史，患有军团病，肌酸磷酸激酶（CPK）升高至 9614mcg/L，符合横纹肌溶解症。他出现严重头痛、食欲不振和血尿，促使他寻求医疗救治。相关的社会史包括他所在社区最近发生的洪水，洪水环绕他家的外围。他的临床表现和实验室检查结果符合军团菌感染，同时伴有急性肾损伤。胸部 X 光片显示左侧肺门周围模糊阴影，考虑为非典型肺炎。立即进行水化和抗原导向的阿奇霉素治疗，以防止快速恶化。他的临床症状没有进一步并发症得到缓解，也没有转入重症监护病房（ICU）。
军团菌引起的横纹肌溶解症是一种罕见的并发症，可导致急性肾衰竭和快速临床恶化。早期和积极的治疗方法包括补液和适当的抗生素，可以改善临床表现和住院时间。我们的患者的 CPK 水平降低和临床改善证实了军团菌感染的肺外累及可导致横纹肌溶解症。医疗保健提供者认识到军团菌肺炎、横纹肌溶解和肾衰竭的临床三联征非常重要，及时的管理可以降低相关发病率。
