Legionnaires' disease with acute renal failure

We describe two patients with Legionnaires' disease (LD) and acute renal failure not associated with hypotension or therapy with nephrotoxic antibiotics. The first patient ran a fulminant course unresponsive to erythromycin therapy and intensive supportive care including mechanical assisted ventilation and peritoneal dialysis. The second patient recovered after erythromycin therapy and hemodialysis. The clinical course of both patients and the renal pathology of the first patient were compatible with acute tubular necrosis. LD is a disease with many extrapulmonary manifestations. The pathogenic mechanism of acute renal failure in LD is presently unknown.