Beyond epidemiology: the importance of molecular methods in the diagnosis of atypical pneumonias
Abstract
Accurate initial diagnosis of acute febrile syndromes with multisystem involvement can be challenging. Leptospirosis, caused by Leptospira spp., is often associated with environmental or occupational exposure, whereas Legionnaires’ disease, caused by Legionella pneumophila , is linked to inhalation of contaminated aerosols. Both conditions may present with similar symptoms, making differentiation essential for appropriate treatment. We report a case of fever, renal failure and rhabdomyolysis as manifestations of an underdiagnosed disease. A 61-year-old male, hypertensive and smoker, was brought by a family member to the emergency department of a tertiary private hospital after onset of high fever, vomiting, diarrhea and lower-limb myalgia. He had returned from Colonia del Sacramento (Uruguay) three days earlier. On admission, he was hemodynamically stable but somnolent, with laboratory results showing leukocytes 17,800/µL (8% bands), creatinine 4.1 mg/dL, urea 88 mg/dL, C-reactive protein 436.9 mg/L and creatine kinase 9,906 U/L. Serology and PCR (reverse transcription polymerase chain reaction) for Leptospira spp. were requested, and ceftriaxone 2g/day IV was started. On the third hospital day, the patient developed hypoxia; chest CT revealed extensive consolidation in the right upper lobe and scattered ground-glass opacities in the right lung, suggestive of alveolar hemorrhage. The patient was intubated due to respiratory failure and underwent bronchoalveolar lavage. The…
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