# Fulminant Rhabdomyolysis and Acute Kidney Injury Associated With Pontiac Fever: A Case Report

## TL;DR

A rare case shows Pontiac fever, a mild Legionella infection, can lead to severe muscle breakdown and kidney failure.

## Contribution

Highlights the rare but severe complications of Pontiac fever, challenging its perception as a mild illness.

## Key findings

- A 24-year-old man with Pontiac fever developed severe rhabdomyolysis and acute kidney injury.
- Creatine kinase levels peaked at 737,860 U/L, requiring renal replacement therapy.
- The case was confirmed via serological testing despite no pulmonary symptoms.

## Abstract

Legionella pneumophila typically manifests in two distinct clinical forms: Legionnaires' disease, characterized by severe pneumonia, and Pontiac fever (PF), a non-pneumonic, influenza-like illness that is usually self-limiting within 2-5 days. While PF is characterized by a high attack rate among exposed individuals in outbreak settings, its true incidence remains unknown and is likely underdiagnosed. Consequently, in routine surveillance data, Legionnaires' disease accounts for the vast majority of reported Legionella infections, with PF representing only a negligible fraction. We report a rare case of a 24-year-old man who presented with high fever, myalgia, and gastrointestinal distress, subsequently developing fulminant rhabdomyolysis. Laboratory findings were remarkable for a peak creatine kinase (CK) level of 737,860 U/L and Kidney Disease: Improving Global Outcomes (KDIGO) stage III acute kidney injury (AKI) requiring renal replacement therapy. Despite the complete absence of pulmonary involvement or hypoxemia, serological testing performed during outpatient follow-up retrospectively confirmed Legionella infection. This case emphasizes that PF, despite its reputation as a mild illness, can rarely precipitate life-threatening systemic muscle destruction and multi-organ dysfunction.