A 47-Year-Old Man with Confusion and Kidney Failure

This case concerns a previously healthy 47-year-old man with acute onset of confusion, myalgias, and kidney failure. Initial labs revealed severe rhabdomyolysis, hyperkalemia, hyponatremia, metabolic acidosis, and elevated hepatic enzymes. Imaging showed right lower lobe consolidation. Despite broad-spectrum antibiotics, fever and hypoxia progressed. A Legionella urinary antigen test confirmed Legionella pneumophila serogroup 1 infection. The presumed source was environmental exposure from a ventilation system in his apartment, formerly a factory. The patient required hemodialysis and heart failure management due to transient left ventricular dysfunction. Treatment with macrolides followed by levofloxacin led to full recovery. Muscle biopsy and genetic studies were suggested due to family history of nemaline myopathy.

This case concerns a previously healthy 47-year-old man with acute onset of confusion, myalgias, and kidney failure. Initial labs revealed severe rhabdomyolysis, hyperkalemia, hyponatremia, metabolic acidosis, and elevated hepatic enzymes. Imaging showed right lower lobe consolidation. Despite broad-spectrum antibiotics, fever and hypoxia progressed. A Legionella urinary antigen test confirmed Legionella pneumophila serogroup 1 infection. The presumed source was environmental exposure from a ventilation system in his apartment, formerly a factory. The patient required hemodialysis and heart failure management due to transient left ventricular dysfunction. Treatment with macrolides followed by levofloxacin led to full recovery. Muscle biopsy and genetic studies were suggested due to family history of nemaline myopathy.