Pathological Evidence of Rhabdomyolysis-induced Acute Tubulointerstitial Nephritis Accompanying Legionella pneumophila Pneumonia
Chie Shimura 1, Takeshi Saraya 1, Hiroo Wada 1, Sinichirou Mikura 1, Saori Takata 1, Tetsuo Yasutake 1, Jundai Kato 1, Aika Kato 1, Masayuki Yamamoto 1, Takuma Yokoyama 1, Masato Watanabe 1, Daisuke Kurai 1, Haruyuki Ishii 1, Masahiro Aoshima 1, Akira Yamada 1 and Hajime Goto 1*
1 Kyorin University of Medicine, Japan
* To whom correspondence should be addressed. E-mail: h510{at}kyorin-u.ac.jp.
Accepted 12 May 2008
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Abstract
We experienced a patient of Legionella pneumophila pneumonia with rhabdomyolysis-induced acute tubulointerstitial nephritis (ATIN) and prolonged renal dysfunction. The case was a 54-year-old man, admitted to our hospital for high-grade fever, ataxia and muscle dysfunction and his chest roentgenogram showed multilobular infiltrations. As L. pneumoniae was detected in his sputum and urine, either by the PCR as well as by culture,he was diagnosed as L. pneumophila pneumonia. Despite the anitmicrobial therapy to Legionella, he further developed renal failure and rhabdomyolysis. The renal biopsy revealed ATIN, by showing the presence of myoglobin casts that occluded the distal tubuli and tubulointerstitial nephritis, leading to the diagnosis of rhabdomyolysis-induced ATIN. Later, the renal function was improved into the normal range, after he discharged on foot. To our knowledge, this is the first pathological evidence that confirmed the involvement of rhabdomyolysis in legionellosis-associated ATIN.
