We herein report the first case of streptococcus pneumonia inducing pneumonia in a patients whose chief complaint was gate disturbance caused by rhabdomyolysis.
An 85-year-old male was unable to move his leg due to pain. He had a history of hypertension, hyperlipidemia, diabetes mellitus, depression, and renal cancer. His vital signs were stable and bilateral legs were cramps resolved by stretching. A complete blood count and serum biochemistry showed a white blood cell level of 26,200/mm3 and a creatine phosphokinase level of 5200 IU/L. He received a diagnosis of muscle cramps induced by rhabdomyolysis. Computed tomography performed to detect the cause of leukocytosis revealed a ground glass appearance in the bilateral lung fields [Figure 1]. He was found to be positive for Streptococcus pneumoniae antigens in the urine and exhibited a high fever with shivering on the 2nd hospital day. Therefore, he received a diagnosis of pneumonia induced by S. pneumoniae with rhabdomyolysis. Later, a positive culture of S. pneumoniae in the sputum was also confirmed. The patient's clinical signs improved after the infusion of ceftriaxone.
Chest computed tomography obtained on arrival reveals a ground glass appearance in the bilateral lung fields
Takayanagi, et al. reported a study of patients with community-acquired pneumonia with rhabdomyolysis. Among 594 cases of pneumonia, 25 patients (2.4%) developed rhabdomyolysis. The leading cause of rhabdomyolysis was Legionella species in 11 cases, influenza virus in six cases, S. pneumonia in four cases, Chlamydia psittaci in three cases, mycoplasma pneumonia in two cases, and unknown in three cases. Blanco, et al. reported that, when S. pneumonia infection is combined with rhabdomyolysis, the leading disease is pneumonia followed by meningitis and arthritis. One hypothesis of the mechanism underlying the development of rhabdomyolysis induced by S. pneumonia is direct infection in the muscle and/or muscle injury caused by toxins produced by S. pneumonia; however, this hypothesis has not been proven yet.
The patient lacked the typical signs and symptoms of pneumonia upon arrival. This may be because local inflammatory reactions tend to weaken due to reduced immunoreactions caused by a high age and diabetes mellitus.
Physicians should be aware that elderly persons with decreased immunoreactions might exhibit a lack of signs and symptoms of primary infections, while accessory complications such as rhabdomyolysis may be at the forefront.
1. Takayanagi N, Tokunaga D, Kubota M, Hara K, Saito H, Ubukata M, et al. Community-acquired pneumonia with rhabdomyolysis. Nihon Kokyuki Gakkai Zasshi. 2005;43:731–5.[PubMed]
2. Blanco JR, Zabalza M, Salcedo J, San Román J. Rhabdomyolysis as a result of Streptococcus pneumoniae: Report of a case and review. Clin Microbiol Infect. 2003;9:944–8.[PubMed]
3. Fung HB, Monteagudo-Chu MO. Community-acquired pneumonia in the elderly. Am J Geriatr Pharmacother. 2010;8:47–62.[PubMed]
This is a case of a 74 year old woman who was diagnosed with
Community Acquired Pneumonia.
Pneumonia is an inflammation or infection of the lungs most commonlycaused by a bacteria or virus. Pneumonia can also be caused by inhaling vomitor other foreign substances. In all cases, the lungs' air sacs fill with pus , mucous,and other liquids and cannot function properly. This means oxygen cannot reachthe blood and the cells of the body.Most pneumonias are caused by bacterial infections.The most commoninfectious cause of pneumonia in the United States is the bacteria Streptococcuspneumoniae. Bacterial pneumonia can attack anyone. The most common causeof bacterial pneumonia in adults is a bacteria called Streptococcus pneumoniaeor Pneumococcus. Pneumococcal pneumonia occurs only in the lobar form.An increasing number of viruses are being identified as the cause of respiratoryinfection. Half of all pneumonias are believed to be of viral origin. Most viralpneumonias are patchy and the body usually fights them off without help frommedications or other treatments.Pneumococcus can affect more than the lungs. The bacteria can also causeserious infections of the covering of the brain (meningitis), the bloodstream, andother parts of the body.
develops in people with limited or no contactwith medical institutions or settings. The most commonly identified pathogensareStreptococcus pneumoniae, Haemophilus influenzae, and atypical organisms(ie, Chlamydia pneumoniae,Mycoplasma pneumoniae, Legionella sp). Symptomsand signs are fever, cough, pleuritic chest pain, dyspnea, tachypnea, andtachycardia. Diagnosis is based on clinical presentation and chest x-ray.Treatment is with empirically chosen antibiotics. Prognosis is excellent for relatively young or healthy patients, but many pneumonias, especially whencaused by S. pneumoniae or influenza virus, are fatal in older, sicker patients.
II. PATIENT PROFILE