Post-infection immunocomplex glomerulonephritis and Legionnaires' disease in a patient with adult Still's disease during treatment with interleukin 1 receptor antagonist anakinra: a case report

A 27-year-old Caucasian woman with known adult Still's disease was admitted to our hospital for community-acquired pneumonia, due to Legionella infection, with acute renal failure. Although her respiratory symptoms responded well to antibiotic treatment, her renal function worsened, with severe proteinuria and edema. A renal biopsy showed extracapillary and endocapillary proliferative glomerulonephritis with accompanying chronic and acute interstitial nephritis. This was consistent with a post-infection immunocomplex glomerulonephritis. After initiation of steroid therapy, her renal function improved. Additionally, therapy with diuretics and an angiotensin-converting enzyme inhibitor was initiated because of persistent proteinuria. Under this treatment regimen, her severe edema and proteinuria disappeared.To the best of our knowledge, there is only a handful of reported cases of post-infection glomerulonephritis with a nephrotic syndrome in a patient with legionellosis. Our findings suggest that, in patients with Legionnaires' disease with renal failure, post-infection immunocomplex glomerulonephritis should be considered and steroid therapy may be an effective modality to treat the renal complication.Legionellosis is a systemic disease that primarily affects the lungs but can also cause dysfunction in many organ systems, including the kidneys. However, there are only a few case reports describing renal dysfunction in this clinical setting [1].Post-infection glomerulonephritis (PIGN) is commonly seen as a complication of infection with nephritogenic strains of group A streptococci. Although Legionnaires' disease was also reported to be one of the infectious causes associated with tubulointerstitial nephritis worldwide, only a handful cases of PIGN have been reported [2,3].A 27-year-old Caucasian woman was brought to the emergency room of our hospital because of newly developed tachycardia with palpitations and hemoptysis. Our patient was receiving regular treatment