A Unique Presentation of Extrapulmonary Legionella: Rhabdomyolysis-Induced Acute Renal Failure and Cerebellar Dysfunction

Abstract

Legionella is most known for causing pneumonia. However, it is a systemic disease that can directly cause severe multi-organ injury in what is sometimes referred to as "extrapulmonary Legionella." In this case report, a reasonably healthy 80-year-old man is found to have Legionella pneumonia complicated by rhabdomyolysis with acute, severe, non-oliguric acute kidney injury, uremic encephalopathy, transaminitis, and cerebellar dysfunction. With a 14-day course of azithromycin and prompt initiation of dialysis, the patient’s pneumonia and systemic sequelae improved. This case demonstrates the importance of considering Legionella in the differential diagnosis of patients who present with community-acquired pneumonia and multi-organ dysfunction. Prompt diagnosis and management may decrease mortality associated with this disease sequela.

Legionella‐induced dysarthria and rhabdomyolysis with acute renal failure achieving recovery

“…Notably, only one case in the literature with a similar presentation to ours involved renal and neurological dysfunction. Unlike our case, the patient was treated with a 14‐day course of azithromycin and reported improvement in dysarthria and ataxia without complete resolution on a one‐month follow‐up 16 . In a small case series that followed the outcomes of neurological dysfunction of LD patients.…”

“…Unlike our case, the patient was treated with a 14-day course of azithromycin and reported improvement in dysarthria and ataxia without complete resolution on a one-month follow-up. 16 In a small case series that followed the outcomes of neurological dysfunction of LD patients. It concluded that out of 17 patients, 12 patients had persistent neurological dysfunction.…”