"Acquired Fanconi Syndrome in the Setting of Legionella Pneumonia" by Ahmed Salik
 

Acquired Fanconi Syndrome in the Setting of Legionella Pneumonia

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

INTRODUCTION: Legionella pneumonia, caused by Legionella pneumophila, is a well-known cause of community-acquired pneumonia. The respiratory manifestations of Legionella infections are well documented; however, extra-pulmonary complications are less frequently reported in the literature. This case report highlights a rare case of a patient with Legionella pneumonia who developed Fanconi syndrome, a renal disorder characterized by proximal tubular dysfunction. CASE DESCRIPTION: A 58-year-old woman with a past medical history of chronic bronchitis presented with complaints of worsening shortness of breath, pleuritic chest pain, productive cough, and fever for the past two days. On examination, she was febrile and hypoxic requiring 2 liters of oxygen by nasal cannula. Rhonchi were heard on auscultation of the left lung field. Laboratory findings revealed elevated white blood cell count, hyponatremia, hypokalemia, and a non-anion-gap metabolic acidosis. Urinalysis showed ketonuria, proteinuria, and a high urine-specific gravity. Chest imaging revealed a consolidation in the left mid to lower lung consistent with pneumonia. Community-acquired pneumonia was diagnosed, and empirical antibiotics (ceftriaxone and azithromycin) were started. Urinary Legionella antigen testing was positive, confirming Legionella pneumophila infection. The patient was subsequently treated with levofloxacin. Her electrolyte abnormalities and symptoms improved significantly within the next 48 hours, and she was discharged in stable condition. DISCUSSION: The patient’s electrolyte abnormalities, non-anion-gap metabolic acidosis, and urinalysis findings were suggestive of proximal tubular dysfunction, which is consistent with a diagnosis of Fanconi Syndrome. The patient had no previous risk factors that would predispose them to Fanconi syndrome, and the resolution of electrolyte abnormalities concurrent with symptomatic improvement in the patient’s condition is highly suggestive that the cause of proximal tubular dysfunction, in this case, was the Legionella infection. Although hyponatremia is commonly observed in Legionella pneumonia, other electrolyte disturbances, such as hypokalemia and metabolic acidosis, are less frequent and may indicate proximal tubular injury. Clinicians should consider testing for Legionella in patients with community-acquired pneumonia who present with abnormal electrolytes and urinalysis findings suggestive of Fanconi syndrome. Case reports and case series have been published previously documenting the association between Legionella pneumonia and Fanconi Syndrome. However, further studies are needed to understand the relationship between Legionella pneumonia and proximal tubular dysfunction.

Volume

211

First Page

A6745

Comments

American Thoracic Society (ATS) International Conference, May 16-21, 2025, San Francisco, CA

Last Page

A6745

DOI

10.1164/ajrccm.2025.211.Abstracts.A6745

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