title: A Case of Pulmonary-Renal Syndrome Leading to the Diagnosis of Legionnaires' Disease.
abstract: We report a case of a 51-year-old Caucasian man referred at our department due to acute renal failure (ARF) complicating respiratory failure during hospitalization in a regional hospital. The patient was previously started on steroids due to the suspicion of rapidly progressive glomerulonephritis (RPGN) in the context of Goodpasture syndrome. However, clinical and laboratory findings did not support this diagnosis; instead a careful evaluation limited differential diagnosis of the renal insult to acute tubular necrosis or acute interstitial nephritis (AIN) following respiratory infection. With lung function fully improved but renal function not recovering, a renal biopsy revealed AIN, a finding leading to further diagnostic testing and finally to the diagnosis of Legionnaires' disease as a cause of this patient's pulmonary-renal syndrome. The management consisted of progressive tapering of oral steroids associated with full recovery of the patient's renal function. This is a rare case of Legionnaires' disease causing immune-mediated AIN and highlights the possibility of Legionella infection as a cause of pulmonary-renal syndrome.
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Erasmia
authors.initials: E
authors.lastname: Sabani
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Pantelis A
authors.identifier: 0000-0002-9174-4018
authors.initials: PA
authors.lastname: Sarafidis
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece; Second Propaedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Antonios
authors.identifier: 0000-0002-7205-4644
authors.initials: A
authors.lastname: Lazaridis
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Theodora
authors.initials: T
authors.lastname: Kouloukourgiotou
authors.affiliation: Department of Nephrology, University Hospital of Heraklion, Andrea Kalokerinou Street, 71500 Heraklion, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stylianou
authors.affiliation: Department of Pathology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Afroditi
authors.initials: A
authors.lastname: Pantzaki
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Aikaterini
authors.identifier: 0000-0003-0437-5208
authors.initials: A
authors.lastname: Papagianni
authors.affiliation: Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Efstratiadis