Pathological evidence of rhabdomyolysis-induced acute tubulointerstitial nephritis accompanying Legionella pneumophila pneumonia

J Clin Pathol. 2008 Sep;61(9):1062-3. doi: 10.1136/jcp.2008.057000. Epub 2008 Jun 13.

Abstract

A case of Legionella pneumophila pneumonia with rhabdomyolysis-induced acute tubulointerstitial nephritis (ATIN) and prolonged renal dysfunction is presented. The patient was a 54-year-old man, admitted with high-grade fever, ataxia and muscle dysfunction; chest roentgenogram showed multilobular infiltrations. L pneumophila was detected in his sputum and urine, by PCR and by culture, and L pneumophila pneumonia was diagnosed. Despite antimicrobial treatment, he developed renal failure and rhabdomyolysis. Renal biopsy showed the presence of myoglobin casts that occluded the distal tubuli and tubulointerstitial nephritis, leading to the diagnosis of rhabdomyolysis-induced ATIN. Renal function subsequently normalised, and he was discharged. This is believed to be the first pathological evidence of involvement of rhabdomyolysis in legionellosis-associated ATIN.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Azithromycin / therapeutic use
  • Ciprofloxacin / therapeutic use
  • Humans
  • Kidney / pathology*
  • Legionella pneumophila*
  • Legionnaires' Disease / complications
  • Legionnaires' Disease / drug therapy
  • Legionnaires' Disease / pathology*
  • Male
  • Middle Aged
  • Nephritis, Interstitial / drug therapy
  • Nephritis, Interstitial / etiology
  • Nephritis, Interstitial / pathology*
  • Rhabdomyolysis / complications
  • Rhabdomyolysis / drug therapy
  • Rhabdomyolysis / pathology*
  • Rifampin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Ciprofloxacin
  • Azithromycin
  • Rifampin