Legionella Pneumonia Associated With Rhabdomyolysis and Acute Renal Failure: A Case Report

Legionnaires' disease is a severe form of pneumonia caused by the bacterium Legionella pneumophila. It comprises around 5% of all community-acquired pneumonia, but up to 20% of all severe community-acquired pneumonia. It often presents with extrapulmonary manifestations, including but not limited to myocarditis, hyponatremia, renal failure, and diarrhea, that have increased in incidence over the last few decades. It has a high hospitalization and mortality rate. The Legionella triad of pneumonia, rhabdomyolysis, and acute renal failure, although rare, has even higher mortality rates, especially in vulnerable population groups. Early recognition, diagnosis, and prompt management can help decrease mortality rates and can help reduce costs by preventing admissions to the intensive care unit. We present the case of a man in his 70s with many comorbidities including heart failure, coronary artery disease, atrial fibrillation, and chronic kidney disease who presented with altered mental status, cough, and fevers, developed the Legionella triad, and required care in the intensive care unit, subsequently needing dialysis as an outpatient due to lack of renal recovery as an inpatient, to highlight the importance of prompt multidisciplinary management to improve overall outcomes.