Severe rhabdomyolysis and acute kidney injury associated with probable Legionella pneumophila infection: a case report
Abstract
Abstract Background Legionella pneumophila infection is an uncommon but recognised precipitator of severe rhabdomyolysis and acute kidney injury. Although this association has previously been described, additional cases have accumulated since the most recent systematic review in 2020. This report combines an atypical, predominantly extrapulmonary presentation with an updated review of subsequently published cases to highlight the evolving spectrum of Legionella -associated muscle and kidney injury and the diagnostic challenges that arise when alternative causes of rhabdomyolysis are plausible. Case presentation A previously independent 78-year-old male presented with three weeks of progressive lower-limb weakness, anorexia, weight loss, dark urine, oliguria, and a preceding flu-like illness. Examination revealed clinical dehydration and marked proximal lower-limb myopathy with preserved upper-limb strength. Initial investigations revealed severe acute kidney injury, with a creatinine level of 989 µmol/L, an eGFR of 4 mL/min/1.73 m², a urea level of 40.2 mmol/L, and a creatine kinase level of 33,400 U/L. Nephrotoxins were withheld, and the patient was treated with intravenous fluids and broad-spectrum antibiotics. Despite this resuscitation, he developed worsening oliguria, metabolic acidosis, and hyperkalaemia requiring haemodialysis. Extensive investigations of autoimmune, inflammatory, haematological, obstructive, medication-related, and metal-ion causes were undertaken.…
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