Acute Tubulointerstitial Nephritis in Legionnaires' Disease
Acute Tubulointerstitial Nephritis in Legionnaires' Disease
Introduction Legionnaires' disease is recognized as a multi-systemic illness. Afflicted patients may have pulmonary, renal, gastrointestinal tract and central nervous system complications. However, renal insufficiency is uncommon. The spectrum of renal involvement may range from a mild and transient elevation of serum creatinine levels to anuric renal failure requiring dialysis and may be linked to several causes. In our present case report, we would like to draw attention to the importance of the pathological documentation of acute renal failure by reporting a case of a patient with acute tubulointerstitial nephritis complicating Legionnaires' disease.
Case presentation A 55-year-old Caucasian man was admitted to our hospital for community-acquired pneumonia complicated by acute renal failure. Legionella pneumophila serogroup type 1 was diagnosed. Although the patient's respiratory illness responded to intravenous erythromycin and ofloxacin therapy, his renal failure worsened, he became anuric, and hemodialysis was started. A renal biopsy was performed, which revealed severe tubulointerstitial nephritis. After initiation of steroid therapy, his renal function improved dramatically.
Conclusions This case highlights the importance of kidney biopsies in cases where acute renal failure is a complicating factor in Legionnaires' disease. If the presence of acute tubulointerstitial nephritis can be confirmed, it will likely respond favorably to steroidal treatment and thus irreversible renal damage and chronic renal failure will be avoided.
Legionnaires' disease (LD), caused by the bacterium Legionella pneumophila, is a leading cause of severe community-acquired pneumonia. It is associated with frequent extrapulmonary symptoms. Acute tubulointerstitial nephritis (TIN) is a rare complication of LD. We report the case of a 55-year-old Caucasian man with anuric acute renal failure (ARF) in a context of LD. A renal biopsy showed severe acute TIN which responded remarkably well to steroid therapy. These findings suggest that when ARF develops in a patient with LD, TIN should be considered as one of the differential diagnoses. Furthermore, this case highlights the importance of renal histology in cases of ARF in LD, because, if acute TIN is documented, systemic corticosteroid therapy may be an effective treatment of ARF, and its rapid initiation may spare the patient from future renal scarring and chronic renal failure.
Abstract and Introduction
Abstract
Introduction Legionnaires' disease is recognized as a multi-systemic illness. Afflicted patients may have pulmonary, renal, gastrointestinal tract and central nervous system complications. However, renal insufficiency is uncommon. The spectrum of renal involvement may range from a mild and transient elevation of serum creatinine levels to anuric renal failure requiring dialysis and may be linked to several causes. In our present case report, we would like to draw attention to the importance of the pathological documentation of acute renal failure by reporting a case of a patient with acute tubulointerstitial nephritis complicating Legionnaires' disease.
Case presentation A 55-year-old Caucasian man was admitted to our hospital for community-acquired pneumonia complicated by acute renal failure. Legionella pneumophila serogroup type 1 was diagnosed. Although the patient's respiratory illness responded to intravenous erythromycin and ofloxacin therapy, his renal failure worsened, he became anuric, and hemodialysis was started. A renal biopsy was performed, which revealed severe tubulointerstitial nephritis. After initiation of steroid therapy, his renal function improved dramatically.
Conclusions This case highlights the importance of kidney biopsies in cases where acute renal failure is a complicating factor in Legionnaires' disease. If the presence of acute tubulointerstitial nephritis can be confirmed, it will likely respond favorably to steroidal treatment and thus irreversible renal damage and chronic renal failure will be avoided.
Introduction
Legionnaires' disease (LD), caused by the bacterium Legionella pneumophila, is a leading cause of severe community-acquired pneumonia. It is associated with frequent extrapulmonary symptoms. Acute tubulointerstitial nephritis (TIN) is a rare complication of LD. We report the case of a 55-year-old Caucasian man with anuric acute renal failure (ARF) in a context of LD. A renal biopsy showed severe acute TIN which responded remarkably well to steroid therapy. These findings suggest that when ARF develops in a patient with LD, TIN should be considered as one of the differential diagnoses. Furthermore, this case highlights the importance of renal histology in cases of ARF in LD, because, if acute TIN is documented, systemic corticosteroid therapy may be an effective treatment of ARF, and its rapid initiation may spare the patient from future renal scarring and chronic renal failure.
