Legionnaire’s Disease Beyond the Lungs: A Rare Case of Severe Rhabdomyolysis and Acute Kidney Injury from a Possible Vaping Source

Abstract

Legionnaires’ disease (LD), caused by Legionella pneumophila, often presents with pneumonia, gastrointestinal symptoms, and confusion. Severe LD can lead to a triad of pneumonia, rhabdomyolysis, and acute kidney injury (AKI), with less common complications such as liver injury. We report a case of a 32-year-old male with no prior medical history who presented with LD complicated by severe rhabdomyolysis, AKI requiring hemodialysis (HD), and acute liver injury. The patient reported 6 days of gastrointestinal symptoms, reduced mobility, and minimal urine output. The patient also reported a history of vaping. Diagnostic imaging revealed pneumonia and enterocolitis, while laboratory findings included leukocytosis, hyponatremia, significantly elevated creatinine kinase (201 000 U/L), and acute transaminitis. A positive Legionella urine antigen confirmed the diagnosis. Initial treatment with azithromycin for 7 days showed partial improvement; however, clinical and laboratory deterioration necessitated a switch to levofloxacin for an additional 7 days. This case highlights rare, severe multi-organ involvement in LD, with rhabdomyolysis and AKI being particularly pronounced. The possible association between vaping and Legionella infection is explored, given the patient’s history of vaping and limited prior documentation of such a link. Prompt recognition, accurate diagnosis, and escalation of therapy are critical in managing severe LD and reducing associated morbidity.