Skip to main content
NCBI home page
Journal of the National Medical Association logoLink to Journal of the National Medical Association
letter
. 1988 Oct;80(10):1065–1071.

Legionnaire's Disease and Acute Renal Failure: A Case Report and Literature Review

Michael C Boucree
PMCID: PMC2625879  PMID: 3074172

Abstract

A case report is presented of a young man admitted to a general hospital with leukocytosis, elevated temperature, right lower lobe infiltrate, and confusion. A diagnosis of rhabdomyolysis, acute renal failure, and Legionnaire's disease was made. The patient subsequently had a respiratory arrest and died on the 29th hospital day. This triad is currently an enigma in the field of internal medicine. The diagnosis of each entity is elusive, and in many cases must be made by the astute clinician. Diagnostic features along with early intervention measures and their expected outcomes are discussed. Recognition of the interrelationship of these diseases, risk factors, and vague clinical presentations might allow further prospective intervention methods and diagnostic procedures to be undertaken to avoid the fatal consequences seen in this disease triad.

Full text

PDF
1065

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barton C. H., Sterling M. L., Vaziri N. D. Rhabdomyolysis and acute renal failure associated with phencyclidine intoxication. Arch Intern Med. 1980 Apr;140(4):568–569. [PubMed] [Google Scholar]
  2. Brivet F., Pham Van T., Petitpretz P., Delfraissy J. F. Rhabdomyolysis, acute renal failure and Legionnaires' disease. Chest. 1984 Dec;86(6):943–944. doi: 10.1378/chest.86.6.943-a. [DOI] [PubMed] [Google Scholar]
  3. Cadnapaphornchai P., Taher S., McDonald F. D. Acute drug-associated rhabdomyolysis: an examination of its diverse renal manifestations and complications. Am J Med Sci. 1980 Sep-Oct;280(2):66–72. doi: 10.1097/00000441-198009000-00001. [DOI] [PubMed] [Google Scholar]
  4. Carrington C. B. Pathology of Legionnaires' disease. Ann Intern Med. 1979 Apr;90(4):496–499. doi: 10.7326/0003-4819-90-4-496. [DOI] [PubMed] [Google Scholar]
  5. Corwin H. L., Schreiber M. J., Fang L. S. Low fractional excretion of sodium. Occurrence with hemoglobinuric- and myoglobinuric-induced acute renal failure. Arch Intern Med. 1984 May;144(5):981–982. doi: 10.1001/archinte.144.5.981. [DOI] [PubMed] [Google Scholar]
  6. Eickhoff T. C. Epidemiology of Legionnaires' disease. Ann Intern Med. 1979 Apr;90(4):499–502. doi: 10.7326/0003-4819-90-4-499. [DOI] [PubMed] [Google Scholar]
  7. Friedman H. M. Legionnaires' disease in non-Legionnaires. A report of five cases. Ann Intern Med. 1978 Mar;88(3):294–302. doi: 10.7326/0003-4819-88-3-294. [DOI] [PubMed] [Google Scholar]
  8. Gabow P. A., Kaehny W. D., Kelleher S. P. The spectrum of rhabdomyolysis. Medicine (Baltimore) 1982 May;61(3):141–152. doi: 10.1097/00005792-198205000-00002. [DOI] [PubMed] [Google Scholar]
  9. Grossman R. A., Hamilton R. W., Morse B. M., Penn A. S., Goldberg M. Nontraumatic rhabdomyolysis and acute renal failure. N Engl J Med. 1974 Oct 17;291(16):807–811. doi: 10.1056/NEJM197410172911601. [DOI] [PubMed] [Google Scholar]
  10. Hall S. L., Wasserman M., Dall L., Schubert T. Acute renal failure secondary to myoglobinuria associated with Legionnaires' disease. Chest. 1983 Nov;84(5):633–635. doi: 10.1378/chest.84.5.633. [DOI] [PubMed] [Google Scholar]
  11. Helms C. M., Viner J. P., Sturm R. H., Renner E. D., Johnson W. Comparative features of pneumococcal, mycoplasmal, and Legionnaires' disease pneumonias. Ann Intern Med. 1979 Apr;90(4):543–547. doi: 10.7326/0003-4819-90-4-543. [DOI] [PubMed] [Google Scholar]
  12. Isenberg H. D. Microbiology of Legionnaires' disease bacterium. Ann Intern Med. 1979 Apr;90(4):502–505. doi: 10.7326/0003-4819-90-4-502. [DOI] [PubMed] [Google Scholar]
  13. Kalish S. B., Tallman M. S., Cook F. V., Blumen E. A. Polymicrobial septicemia associated with rhabdomyolysis, myoglobinuria, and acute renal failure. Arch Intern Med. 1982 Jan;142(1):133–134. [PubMed] [Google Scholar]
  14. Kirby B. D., Snyder K. M., Meyer R. D., Finegold S. M. Legionnaires' disease: clinical features of 24 cases. Ann Intern Med. 1978 Sep;89(3):297–309. doi: 10.7326/0003-4819-89-3-297. [DOI] [PubMed] [Google Scholar]
  15. Knochel J. P., Barcenas C., Cotton J. R., Fuller T. J., Haller R., Carter N. W. Hypophosphatemia and rhabdomyolysis. J Clin Invest. 1978 Dec;62(6):1240–1246. doi: 10.1172/JCI109244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Knochel J. P. Rhabdomyolysis and myoglobinuria. Annu Rev Med. 1982;33:435–443. doi: 10.1146/annurev.me.33.020182.002251. [DOI] [PubMed] [Google Scholar]
  17. Knochel J. P. Serum calcium derangements in rhabdomyolysis. N Engl J Med. 1981 Jul 16;305(3):161–163. doi: 10.1056/NEJM198107163050307. [DOI] [PubMed] [Google Scholar]
  18. Koffler A., Friedler R. M., Massry S. G. Acute renal failure due to nontraumatic rhabdomyolysis. Ann Intern Med. 1976 Jul;85(1):23–28. doi: 10.7326/0003-4819-85-1-23. [DOI] [PubMed] [Google Scholar]
  19. Miller A. C. Early clinical differentiation between Legionnaires' disease and other sporadic pneumonias. Ann Intern Med. 1979 Apr;90(4):526–528. doi: 10.7326/0003-4819-90-4-526. [DOI] [PubMed] [Google Scholar]
  20. Patel R., Das M., Palazzolo M., Ansari A., Balasubramaniam S. Myoglobinuric acute renal failure in phencyclidine overdose: report of observations in eight cases. Ann Emerg Med. 1980 Nov;9(11):549–553. doi: 10.1016/s0196-0644(80)80222-8. [DOI] [PubMed] [Google Scholar]
  21. Posner M. R., Caudill M. A., Brass R., Ellis E. Legionnaires' disease associated with rhabdomyolysis and myoglobinuria. Arch Intern Med. 1980 Jun;140(6):848–850. [PubMed] [Google Scholar]
  22. Richter R. W., Challenor Y. B., Pearson J., Kagen L. J., Hamilton L. L., Ramsey W. H. Acute myoglobinuria associated with heroin addiction. JAMA. 1971 May 17;216(7):1172–1176. [PubMed] [Google Scholar]
  23. Rodriguez E. E., Woods K. L., Deno R. E., Wallin J. D., O'Neill W. M., Jr Rhabdomyolysis-induced acute renal failure in Legionnaires' disease. South Med J. 1983 Oct;76(10):1328–1329. doi: 10.1097/00007611-198310000-00041. [DOI] [PubMed] [Google Scholar]
  24. Ron D., Taitelman U., Michaelson M., Bar-Joseph G., Bursztein S., Better O. S. Prevention of acute renal failure in traumatic rhabdomyolysis. Arch Intern Med. 1984 Feb;144(2):277–280. [PubMed] [Google Scholar]
  25. Swartz M. N. Clinical aspects of Legionnaires' disease. Ann Intern Med. 1979 Apr;90(4):492–495. doi: 10.7326/0003-4819-90-4-492. [DOI] [PubMed] [Google Scholar]
  26. Tsai T. F., Finn D. R., Plikaytis B. D., McCauley W., Martin S. M., Fraser D. W. Legionnaires' disease: clinical features of the epidemic in Philadelphia. Ann Intern Med. 1979 Apr;90(4):509–517. doi: 10.7326/0003-4819-90-4-509. [DOI] [PubMed] [Google Scholar]
  27. Ward P. A. Immunology and immunopathology of Legionnaires' disease. Ann Intern Med. 1979 Apr;90(4):506–508. doi: 10.7326/0003-4819-90-4-506. [DOI] [PubMed] [Google Scholar]
  28. Williams M. E., Watanakunakorn C., Baird I. M., Gerald S. E. Legionnaires' disease with acute renal failure. Am J Med Sci. 1980 May-Jun;279(3):177–183. doi: 10.1097/00000441-198005000-00008. [DOI] [PubMed] [Google Scholar]
  29. Wong K. H., Moss C. W., Hochstein D. H., Arko R. J., Schalla W. O. "Endotoxicity" of the Legionnaires' disease bacterium. Ann Intern Med. 1979 Apr;90(4):624–627. doi: 10.7326/0003-4819-90-4-624. [DOI] [PubMed] [Google Scholar]
  30. el-Nahas A. M., Farrington K., Quyyumi S., Moorhead J. F., Sweny P. Rhabdomyolysis and systemic infection. Br Med J (Clin Res Ed) 1983 Jan 29;286(6362):349–350. doi: 10.1136/bmj.286.6362.349-a. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES