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Case Reports
. 2023 May 9:11:1145733.
doi: 10.3389/fpubh.2023.1145733. eCollection 2023.

Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review

Rao Du #  1 , Yinhe Feng #  2 , Yubin Wang  1 , Jifeng Huang  1 , Yuhan Tao  1 , Hui Mao  1
Affiliations
Case Reports

Metagenomic next-generation sequencing confirms the diagnosis of Legionella pneumonia with rhabdomyolysis and acute kidney injury in a limited resource area: a case report and review

Rao Du et al. Front Public Health. .

Abstract

Background: Legionella pneumonia, rhabdomyolysis, and acute kidney injury are called the Legionella triad, which is rare and associated with a poor outcome and even death. Early diagnosis and timely treatment are essential for these patients.

Case presentation: A 63-year-old man with cough, fever, and fatigue was initially misdiagnosed with common bacterial infection and given beta-lactam monotherapy but failed to respond to it. Conventional methods, including the first Legionella antibody test, sputum smear, and culture of sputum, blood, and bronchoalveolar lavage fluid (BALF) were negative. He was ultimately diagnosed with a severe infection of Legionella pneumophila by metagenomics next-generation sequencing (mNGS). This patient, who had multisystem involvement and manifested with the rare triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury, finally improved after combined treatment with moxifloxacin, continuous renal replacement therapy, and liver protection therapy.

Conclusion: Our results showed the necessity of early diagnosis of pathogens in severe patients, especially in Legionnaires' disease, who manifested with the triad of Legionella pneumonia, rhabdomyolysis, and acute kidney injury. mNGS may be a useful tool for Legionnaires' disease in limited resource areas where urine antigen tests are not available.

Keywords: Legionella pneumonia; acute kidney injury; case report; metagenomic next-generation sequencing; rhabdomyolysis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Chest computed tomography (CT) of the patient. (A, B) Chest CT on the first day of admission to the emergency department showed consolidation of the lower lobes of both lungs; (C, D) Chest CT 23 days after moxifloxacin treatment showed that the lesions were significantly absorbed.
Figure 2
Figure 2
The corresponding reads of detected microorganism in (A) BALF and (B) lung tissue.
Figure 3
Figure 3
Some clinical indicators of this patient during hospitalization. (A) Creatinine and CK levels; (B) ALT, AST, and LDH levels; (C) WBC and body temperature; (D) PCT, CRP levels.
Figure 4
Figure 4
Timeline of the patient with relevant data of the episodes and interventions.
See this image and copyright information in PMC

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