Rhabdomyolysis and Acute Kidney Injury Associated With Acute Legionella Infection

BACKGROUND Legionella pneumophila is a common and often severe cause of community-acquired pneumonia. Infection with this organism is also known to be associated with a wide range of extrapulmonary manifestations, such as neurologic deficits, hyponatremia, acute kidney injury, and elevated liver enzymes. Other complications, such as rhabdomyolysis and hypertriglyceridemia, are rare. CASE REPORT A rare presentation of Legionella infection was observed in a 34-year-old man, characterized by severe rhabdomyolysis, acute kidney injury (AKI), and hypertriglyceridemia. The patient presented with severe muscle cramps, weakness, dark urine, diarrhea, fever, and chills. Initial laboratory evaluations revealed significantly elevated creatine kinase (163 600 U/L), creatinine (7.79 mg/dL), and transaminases (AST 1179 U/L, ALT 184 U/L), in conjunction with hyponatremia. A chest X-ray and computed tomography (CT) showed left basilar pneumonia, and a positive Legionella urine antigen test confirmed the diagnosis. A fasting lipid panel also revealed profound hypertriglyceridemia (1173 mg/dL). The patient's only identified risk factor for Legionella infection was vaping. Despite aggressive therapeutic interventions, including intravenous fluids and azithromycin, AKI progressed, necessitating hemodialysis. The patient also received treatment for alcohol withdrawal and severe hypertension. While creatine kinase, AST, and ALT levels gradually decreased, BUN and creatinine remained elevated at discharge, with ongoing plans for outpatient hemodialysis. CONCLUSIONS Legionella pneumonia can present with a diverse array of extrapulmonary manifestations. This case illustrates the diverse and potentially life-threatening systemic complications associated with Legionella infection.