A Unique Presentation of Extrapulmonary Legionella: Rhabdomyolysis-Induced Acute Renal Failure and Cerebellar Dysfunction

Abstract

Legionella is most known for causing pneumonia. However, it is a systemic disease that can directly cause severe multi-organ injury in what is sometimes referred to as "extrapulmonary Legionella." In this case report, a reasonably healthy 80-year-old man is found to have Legionella pneumonia complicated by rhabdomyolysis with acute, severe, non-oliguric acute kidney injury, uremic encephalopathy, transaminitis, and cerebellar dysfunction. With a 14-day course of azithromycin and prompt initiation of dialysis, the patient's pneumonia and systemic sequelae improved. This case demonstrates the importance of considering Legionella in the differential diagnosis of patients who present with community-acquired pneumonia and multi-organ dysfunction. Prompt diagnosis and management may decrease mortality associated with this disease sequela.

Keywords: cerebellar ataxia; dialysis; dysarthria; extrapulmonary legionella; legionella; legionella pneumonia; neurologic symptoms; rhabdomyolysis with acute renal failure; transaminitis; uremic encephalopathy.

Figure 1. Initial chest X-ray

Figure 2. Computed tomography scan of the chest without contrast showing small bilateral pulmonary effusions (red arrows)