SHM Converge Scientific Abstract ePoster Gallery-Something in the Water: What Can Cause Encephalopathy and Rhabdomyolysis?

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This case describes a 50-year-old man with no major medical history who presented with altered mental status, dysarthria, fever, weakness, and severe rhabdomyolysis. He was initially suspected to have had a stroke, but head CT was normal. Laboratory studies showed marked muscle injury and organ dysfunction, including very high CPK, elevated liver enzymes, rising creatinine, and troponin elevation.

During hospitalization, his condition worsened despite intravenous fluids. His CPK climbed to 163,200 and he became anuric, requiring hemodialysis. Blood cultures grew Gram-positive bacteria later identified as <em>Staphylococcus lugdunensis</em>, and he was treated with cefazolin. Because of his neurologic symptoms and extensive workup, additional studies were performed, including MRI of the brain showing multiple sclerosis lesions, positive MS testing, and lumbar puncture findings consistent with inflammation. He also had a chest X-ray showing right lower lobe pneumonia.

A key clue came from the family history: he had recently returned from a cruise to the Bahamas. Legionella urine antigen testing was positive, suggesting Legionnaire’s disease from contaminated water exposure. Azithromycin was started before dialysis, and his CPK began to decline afterward.

The patient improved significantly with azithromycin for Legionella, cefazolin for bacteremia, high-dose IV steroids for an incidental multiple sclerosis flare, and hemodialysis for renal failure. His encephalopathy and dysarthria resolved, and he was discharged with outpatient dialysis.

The report highlights a rare presentation of Legionnaire’s disease, emphasizing that <em>Legionella pneumophilia</em> can present not only with pneumonia but also with encephalopathy and rhabdomyolysis. Early recognition and treatment are important, as muscle breakdown has been repeatedly reported in Legionella infections and often improves with appropriate antibiotics, typically azithromycin for 10–14 days.

Asset Subtitle

Lily Nguyen

Meta Tag

Author List Cameron Palmer, Cayleigh Blumrick, Elsie Amoako-Kissi, James R. Wyant, Joseph Carton, Lily Nguyen, Sami Tahhan, Waleed Kassabo

Category Clinical Vignettes

Concept Rhabdomyolysis

Concept Legionella pneumophila

Concept Acute Renal Failure

Concept Encephalopathy

Concept Legionnaires Disease

Distinguished Non-Finalist

Presenter Organization Eastern Virginia Medical School

Presenting Author Lily Nguyen

Track Adult

Keywords

Legionnaire’s disease

Legionella pneumophila

rhabdomyolysis

encephalopathy

hemodialysis

staphylococcus lugdunensis

multiple sclerosis flare

azithromycin

pneumonia

cruise exposure

Rhabdomyolysis

Legionella pneumophila

Acute Renal Failure

Encephalopathy

Legionnaires Disease