Recovery after more than one month of dialysis in legionella-associated acute kidney injury: a case evaluated with gallium-67 scintigraphy and renal biopsy.
Takuya Kumagai, Masaya Saito, Yuna Tamori et al.
✦ AI-curated · Sources linked
Case in brief
A 73-year-old man developed dialysis-dependent acute kidney injury during severe Legionella pneumonia. Although the infection resolved and antibiotics had been stopped, kidney injury persisted for more than a month. Urinary beta2-microglobulin was markedly elevated, and gallium-67 scintigraphy showed intense bilateral renal uptake, supporting ongoing inflammation. Prednisolone was started as a diagnostic trial; urine output then increased, creatinine fell, and dialysis was stopped. Renal function returned to baseline. Biopsy after stabilization showed acute tubular injury with chronic tubulointerstitial changes and focal reactive T-cell infiltration; prior or partially treated tubulointerstitial nephritis could not be excluded.
What made this case unusual
Despite more than a month of dialysis dependence, the patient recovered to baseline renal function. Intense bilateral renal gallium-67 uptake and elevated urinary beta2-microglobulin provided ancillary evidence of ongoing inflammation when biopsy was not initially feasible, although later biopsy did not establish tubulointerstitial nephritis.
Diagnostic / clinical pearl
In prolonged Legionella-associated AKI, persistent tubular injury may coexist with evidence of renal inflammation. Gallium-67 scintigraphy and serial urinary tubular injury markers can provide ancillary diagnostic information when biopsy is not immediately feasible.