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Pathological Evidence of Rhabdomyolysis-induced Acute Tubulointerstitial Nephritis Accompanying Legionella pneumophila Pneumonia
  1. Chie Shimura (chiettu{at}kyorin-u.ac.jp)
  1. Kyorin University of Medicine, Japan
    1. Takeshi Saraya (saori0703{at}fiberbit.net)
    1. Kyorin University of Medicine, Japan
      1. Hiroo Wada (wadagh{at}kyorin-u.ac.jp)
      1. Kyorin University of Medicine, Japan
        1. Sinichirou Mikura (saori0703{at}fiberbit.net)
        1. Kyorin University of Medicine, Japan
          1. Saori Takata (saori0703{at}fiberbit.net)
          1. Kyorin University of Medicine, Japan
            1. Tetsuo Yasutake (saori0703{at}fiberbit.net)
            1. Kyorin University of Medicine, Japan
              1. Jundai Kato (saori0703{at}fiberbit.net)
              1. Kyorin University of Medicine, Japan
                1. Aika Kato (saori0703{at}fiberbit.net)
                1. Kyorin University of Medicine, Japan
                  1. Masayuki Yamamoto (saori0703{at}fiberbit.net)
                  1. Kyorin University of Medicine, Japan
                    1. Takuma Yokoyama (saori0703{at}fiberbit.net)
                    1. Kyorin University of Medicine, Japan
                      1. Masato Watanabe (saori0703{at}fiberbit.net)
                      1. Kyorin University of Medicine, Japan
                        1. Daisuke Kurai (saori0703{at}fiberbit.net)
                        1. Kyorin University of Medicine, Japan
                          1. Haruyuki Ishii (saori0703{at}fiberbit.net)
                          1. Kyorin University of Medicine, Japan
                            1. Masahiro Aoshima (saori0703{at}fiberbit.net)
                            1. Kyorin University of Medicine, Japan
                              1. Akira Yamada (saori0703{at}fiberbit.net)
                              1. Kyorin University of Medicine, Japan
                                1. Hajime Goto (h510{at}kyorin-u.ac.jp)
                                1. Kyorin University of Medicine, Japan

                                  Abstract

                                  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.

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