Abstract
A 50-year-old man was admitted to our hospital with pyrexia of 38°C and dyspnea. Chest X-ray film showed infiltration of the right lower field, and the serum creatinine was 4.01 mg/dL. We suspected atypical pneumonia, and cefozopran (CZOP) and minocycline (MINO) therapy was started. Although his general condition improved, renal function gradually deteriorated without an increase creatine phosphokinase level. On the 2nd hospital day, hemodialysis was started to treat acute renal failure. Renal function was improved after two hemodialysis sessions. On the 5th hospital day, a urinary Legionella antigen test proved positive ; consequently, the antibiotic therapy was switched to ciprofloxacin (CPFX) and MINO. Finally, on the 12th hospital day, the patient was discharged from our hospital without renal dysfunction. Rhabdomyolysis is often seen in certain cases of Legionella pneumonia associated with acute renal failure. However, in the present case, the patient's creatine phosphokinase level was normal ; therefore, rhabdomyolysis was not the cause of the observed acute renal failure. We consider that endotoxemia, direct microbial toxicity, inflammatory cytokines, or NSAIDS could have caused this patient's acute renal failure.
