A case of Legionella pneumonia with rhabdomyolysis, with extremely high creatinine kinase without acute kidney injury in an adult
  • Sangam Sangam
    Division of Internal Medicine, St. Barnabas Hospital, New York, USA
  • Sehrish Malik
    CUNY School of Medicine, New York, USA
  • Franc Hodo
    Division of Internal Medicine, St. Barnabas Hospital, New York, USA
  • Bhawesh Patel
    Division of Internal Medicine, St. Barnabas Hospital, New York, USA
  • Victoria Bengualid
    Division of Infectious Diseases, St. Barnabas Hospital, New York, USA
  • Shorabh Sharma
    Division of Internal Medicine, St. Barnabas Hospital, New York, USA

Keywords

Legionella pneumonia, rhabdomyolysis, creatine kinase, CPK, acute kidney injury

Abstract

Legionella pneumophila is a bacterium that usually causes pulmonary disease but can rarely present with extrapulmonary manifestations, such as rhabdomyolysis. This is a case of Legionella infection with significant rhabdomyolysis but a lack of acute kidney injury.
A 38-year-old male with a history of epilepsy presented to the emergency department after a seizure episode with confusion, fever, emesis and bruises. He also complained of a productive cough and scant haemoptysis for the past two months. Chest X-ray showed retrocardiac and left upper lobe opacities; urine was positive for Legionella antigen and myoglobinuria. Creatinine phosphokinase was 242,488 U/l and creatinine was 0.5 mg/dl. The patient was managed with oxygen therapy, aggressive IV hydration and IV azithromycin, and later IV levofloxacin until his symptoms resolved.
Rhabdomyolysis may be a sign of Legionella infection. Rapid testing of Legionella antigen, especially in populations at risk, may be crucial for timely diagnosis and treatment. Kidney function may be preserved in the early stages of disease, but early treatment with antibiotics and aggressive hydration are an effective way to prevent deterioration in kidney function.

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References

  • Koufakis T, Gabranis I, Chatzopoulou M, Margaritis A, Tsiakalou M. Severe Legionnaires’ disease complicated by rhabdomyolysis and clinically resistant to moxifloxacin in a splenectomised patient: too much of a coincidence? Case Reports in Infectious Diseases 2015;2015:793786.
  • Soni AJ, Peter A. Established association of legionella with rhabdomyolysis and renal failure: a review of the literature. Respir Med Case Rep 2019;28:100962.
  • Sutarjono B, Alexis J, Sachidanandam JC. Legionella pneumonia complicated by rhabdomyolysis. BMJ Case Rep 2019;12:e229243.
  • Hansrivijit P, Yarlagadda K, Puthenpura MM, Cunningham JM. Extremely high creatine kinase activity in rhabdomyolysis without acute kidney injury. Am J Case Rep 2020;21:e924347.
  • Singh U, Scheld WM. Infectious etiologies of rhabdomyolysis: three case reports and review. Clin Infect Dis 1996;22:642–649.
  • Ma H, Bavishi A, Jain B. Legionella associated rhabdomyolysis: a case report. J Medl Case Rep 2023;17:258.
  • Veenstra J, Smit WM, Krediet RT, Arisz L. Relationship between elevated creatine phosphokinase and the clinical spectrum of rhabdomyolysis. Nephrol Dial Transplant 1994;9:637–641.
  • Safari S, Yousefifard M, Hashemi B, Baratloo A, Forouzanfar MM, Rahmati F, et al. The value of serum creatine kinase in predicting the risk of rhabdomyolysis-induced acute kidney injury: a systematic review and meta-analysis. Clin Exp Nephrol 2016;20:153–161.
  • de Meijer AR, Fikkers BG, de Keijzer MH, van Engelen BG, Drenth JP. Serum creatine kinase as predictor of clinical course in rhabdomyolysis: a 5-year intensive care survey. Intensive Care Med 2003;29:1121–1125.
  • Soliman A, Bisht S, Jeyamurugan K, Balasundaram P, Basak R. Severe rhabdomyolysis in a pediatric patient after Coxsackie B virus infection without acute renal failure: a case report. Cureus 2020;12:e7126.
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    Published: 2024-07-04
    Issue: 2024: LATEST ONLINE (view)


    How to cite:
    1.
    Sangam S, Malik S, Hodo F, Patel B, Bengualid V, Sharma S. A case of Legionella pneumonia with rhabdomyolysis, with extremely high creatinine kinase without acute kidney injury in an adult. EJCRIM 2024;11 doi:10.12890/2024_004539.

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