Pulmonary Renal Syndrome Leading to the Diagnosis of Legionnaires Disease

A 51-year-old man was referred to the tertiary Department of Nephrology from a regional hospital, due to acute renal failure (ARF) following a severe lung infection. MEDICAL HISTORY 15 days ago, the patient presented to the emergency room (ER) of the regional hospital with fever (up to 40°C), chills, and productive cough for three days prior to his admission. At ER presentation Auscultation of the chest revealed diffuse bilateral crackles. The rest of the clinical examination was normal.

A chest radiograph showed bilateral lower lung infiltrates and a computed tomography (CT) revealed diffuse bilateral opacities in the lower lobes (Figure 1). At tertiary Department of Nephrology The patient was afebrile, BP: 158/80mmHg, Pulse: 71 beats per minute, Respiratory rate: 25 breaths/minute, Oxygen saturation: 94% in room air. Blood gas showed pH = 7.35, pO2 = 80.5mmHg, pCO2 = 20.7mmHg, HCO3 =…