Legionnaires' disease with rhabdomyolysis and acute reversible myoglobinuric renal failure

Hypertriglyceridemia and massive rhabdomyolysis in a patient with disseminated legionella

Legionella most commonly presents as pneumonia but can have disseminated involvement, presenting as extra-pulmonary disease involving gastrointestinal, neurological, cardiac, renal, and musculoskeletal systems, and skin and soft tissues. We present a case of a patient with pneumonia, rhabdomyolysis, renal failure, hypertriglyceridemia, pancreatitis, and cutaneous involvement. This case highlights the breath of involvement legionella can have, including the never previously documented manifestation of hypertriglyceridemia and severe rhabdomyolysis with the highest creatinine kinase recorded.

Myositis and acute kidney injury in bacterial atypical pneumonia: Systematic literature review

BACKGROUND

Bacterial community-acquired atypical pneumonia is sometimes complicated by a myositis or by a renal parenchymal disease. Available reviews do not mention the concurrent occurrence of both myositis and acute kidney injury.

METHODS

In order to characterize the link between bacterial community-acquired atypical pneumonia and both myositis and a renal parenchymal disease, we reviewed the literature (United States National Library of Medicine and Excerpta Medica databases).

RESULTS

We identified 42 previously healthy subjects (35 males and 7 females aged from 2 to 76, median 42 years) with a bacterial atypical pneumonia associated both with myositis (muscle pain and creatine kinase ≥5 times the upper limit of normal) and acute kidney injury (increase in creatinine to ≥1.5 times baseline or increase by ≥27 μmol/L above the upper limit of normal). Thirty-six cases were caused by Legionella species (N = 27) and by Mycoplasma pneumoniae (N = 9). Further germs accounted for the remaining 6 cases. The vast majority of cases (N = 36) presented a diffuse myalgia. Only a minority of cases (N = 3) were affected by a calf myositis. The diagnosis of rhabdomyolysis-associated kidney injury was retained in 37 and that of acute interstitial nephritis in the remaining 5 cases.

CONCLUSION

Bacterial atypical pneumonia may occasionally induce myositis and secondary kidney damage.

Lp25 membrane protein from pathogenic Leptospira spp. is associated with rhabdomyolysis and oliguric acute kidney injury in a guinea pig model of leptospirosis

Acute kidney injury (AKI) from leptospirosis is frequently nonoliguric with hypo- or normokalemia. Higher serum potassium levels are observed in non-survivor patients and may have been caused by more severe AKI, metabolic disarrangement, or rhabdomyolysis. An association between the creatine phosphokinase (CPK) level and maximum serum creatinine level has been observed in these patients, which suggests that rhabdomyolysis contributes to severe AKI and hyperkalemia. LipL32 and Lp25 are conserved proteins in pathogenic strains of Leptospira spp., but these proteins have no known function. This study evaluated the effect of these proteins on renal function in guinea pigs. Lp25 is an outer membrane protein that appears responsible for the development of oliguric AKI associated with hyperkalemia induced by rhabdomyolysis (e.g., elevated CPK, uric acid and serum phosphate). This study is the first characterization of a leptospiral outer membrane protein that is associated with severe manifestations of leptospirosis. Therapeutic methods to attenuate this protein and inhibit rhabdomyolysis-induced AKI could protect animals and patients from severe forms of this disease and decrease mortality.

Legionella pneumonia presenting with rhabdomyolysis and acute renal failure: A case report

Legionella pneumophila infection is a recognized but rare cause of rhabdomyolysis. While the mechanism of rhabdomyolysis associated with Legionella is unknown, theories include direct invasion of Legionella into the muscle itself, or the release of its endotoxin into the circulation with subsequent muscle injury. In this case report, we describe a case of Legionella pneumonia presenting as altered mental status, high fever, and rhabdomyolysis with acute renal failure. We review the epidemiology, clinical and laboratory findings, and treatment of the disease.

Reactive knee and ankle joint arthritis: abnormal manifestation of Legionella pneumophila

This case report demonstrates that active legionellosis is not always characterised by pulmonary symptoms and specific radiomorphological findings. Whereas the initial clinical presentation, as described in the literature, includes fever, cough, expectoration, extrapulmonary organ changes or typical laboratory findings, atypical manifestations such as reactive arthritis must be considered.