Work

Severe Legionella pneumophila pneumonia complicated by rhabdomyolysis and myocarditis: a case report

Year: 2026

Type: article

Abstract: Background Legionella pneumophila pneumonia may be missed when extrapulmonary manifestations dominate the early clinical picture. Rhabdomyolysis and myocarditis are uncommon but serious complications that may be overlooked. In patients whose early manifestations are dominated by extrapulmonary abnormalities, paired respiratory and blood metagenomic sequencing may help link the pulmonary source with possible systemic involvement. Case presentation We report a 57-year-old previously healthy man who presented with high fever, diffuse myalgia, generalized weakness, abdominal distension, headache, mild disorientation, and dark-colored urine, with limited respiratory symptoms. Laboratory tests showed marked systemic inflammation, rhabdomyolysis, hepatic injury, and elevated cardiac biomarkers. Chest computed tomography revealed unilateral pulmonary consolidation. Because of severe pneumonia with multisystem involvement, bronchoalveolar lavage fluid and whole blood were examined simultaneously by metagenomic next-generation sequencing. Legionella pneumophila was detected in both specimens, supporting pulmonary infection with probable systemic involvement. Cardiac magnetic resonance imaging later showed subepicardial late gadolinium enhancement consistent with myocarditis. After targeted anti- Legionella therapy, fever and systemic symptoms improved rapidly, followed by gradual resolution of inflammatory abnormalities, muscle injury, cardiac biomarker elevation, and pulmonary infiltrates. Conclusion This case suggests that Legionella pneumonia should remain in the differential diagnosis when severe systemic inflammation is accompanied by rhabdomyolysis or unexplained myocardial injury, even if respiratory symptoms are not prominent. Paired respiratory and blood metagenomic sequencing may provide complementary diagnostic information in selected patients with severe atypical pneumonia when extrapulmonary organ involvement is disproportionate to respiratory symptoms.

Source: BMC Pulmonary Medicine

DOI: 10.1186/s12890-026-04703-3

Authors: Yu Gu, Peixi Zhou, Jinghan Lei, Shunyao Cui, Yuanxing Wu

Institutions: Capital Medical University, Beijing Anzhen Hospital

Language: English

Topic: Legionella and Acanthamoeba research

Subfield: Endocrinology

Field: Biochemistry, Genetics and Molecular Biology

Domain: Life Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,090