Myositis and acute kidney injury in bacterial atypical pneumonia: Systematic literature review

• Published in: Journal of infection and public health 2020-12, Vol.13 (12), p.2020-2024
• Main Authors: Simoni, Chiara, Camozzi, Pietro, Faré, Pietro B., Bianchetti, Mario G., Kottanattu, Lisa, Lava, Sebastiano A.G., Milani, Gregorio P.
• Format: Article
• Language: English
• Subjects: Acute kidney injury; Acute Kidney Injury - etiology; Acute renal failure; Adult; Chlamydia; Community-Acquired Infections - diagnosis; Female; Humans; Male; Mycoplasma; Myositis - complications; Myositis - diagnosis; Nephritis, Interstitial; Pneumonia, Bacterial - complications; Pneumonia, Mycoplasma; Rhabdomyolysis
• ISSN: 1876-0341; 1876-035X
• DOI: 10.1016/j.jiph.2020.10.007

Bacterial community-acquired atypical pneumonia is sometimes complicated by a myositis or by a renal parenchymal disease. Available reviews do not mention the concurrent occurrence of both myositis and acute kidney injury. In order to characterize the link between bacterial community-acquired atypical pneumonia and both myositis and a renal parenchymal disease, we reviewed the literature (United States National Library of Medicine and Excerpta Medica databases). We identified 42 previously healthy subjects (35 males and 7 females aged from 2 to 76, median 42 years) with a bacterial atypical pneumonia associated both with myositis (muscle pain and creatine kinase ≥5 times the upper limit of normal) and acute kidney injury (increase in creatinine to ≥1.5 times baseline or increase by ≥27 μmol/L above the upper limit of normal). Thirty-six cases were caused by Legionella species (N = 27) and by Mycoplasma pneumoniae (N = 9). Further germs accounted for the remaining 6 cases. The vast majority of cases (N = 36) presented a diffuse myalgia. Only a minority of cases (N = 3) were affected by a calf myositis. The diagnosis of rhabdomyolysis-associated kidney injury was retained in 37 and that of acute interstitial nephritis in the remaining 5 cases. Bacterial atypical pneumonia may occasionally induce myositis and secondary kidney damage.