Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Brennan Medlin, OMS-III 1 ; Tim Gilbert MD 2 1 VCOM-Louisiana; 2 Division of Internal Medicine, Department of Medicine, Baton Rouge General Hospital 56 EXTRAPULMONARY COMPLICATIONS OF LEGIONELLA PNEUMONIA: RHADBOMYOLYSIS, TRANSAMINITIS, AND ACUTE KIDNEY INJURY

Crystalyn Jordan, OMS-III VCOM-Louisiana 55 DEVELOPMENT OF A LEFT VENTRICULAR APICAL ANEURYSM FOLLOWING ST-ELEVATION MYOCARDIAL INFARCTION

Context: Left ventricular apical aneurysm is a serious mechanical complication of transmural myocardial infarction, most commonly following anterior ST-elevation myocardial infarction due to left anterior descending artery occlusion. Although early reperfusion strategies have reduced its incidence, ventricular aneurysm formation remains associated with significant morbidity, including heart failure, malignant arrhythmias, thromboembolism, and sudden cardiac death. Early recognition and timely imaging are essential to guide management and prevent life-threatening outcomes. Report of Case: A 65-year-old female with a history of hypertension, hyperlipidemia, and poorly controlled type 2 diabetes mellitus presented with chest pain and was found to have an anterior ST-elevation myocardial infarction. Cardiac catheterization revealed a 100% occlusion of the left anterior descending artery, which was treated with percutaneous coronary intervention and drug eluting stent placement. Initial transthoracic echocardiography demonstrated a reduced left ventricular ejection fraction of 35% with apical akinesis but no aneurysm. Her hospital

course was complicated by recurrent atrial and ventricular arrhythmias, progressive heart failure, and cardiogenic shock requiring advanced pharmacologic and electrical rhythm management. On readmission one week after discharge for decompensated heart failure, repeat echocardiography revealed aneurysmal involvement of the apical septal, apical lateral, and apical segments. Definitive characterization of the aneurysm with cardiac magnetic resonance imaging was attempted, but could not be completed due to hemodynamic instability and respiratory intolerance. Conclusions: This case highlights the progressive nature of post-infarction ventricular remodeling and the diagnostic challenges encountered when clinical deterioration limits advanced imaging. Despite guideline directed medical therapy and revascularization, the patient developed a left ventricular apical aneurysm complicated by refractory arrhythmias and cardiogenic shock. Early surveillance imaging and multidisciplinary management are critical in identifying ventricular aneurysm formation and mitigating associated complications. This case underscores the

importance of timely post-myocardial infarction evaluation, particularly in high-risk patients with extensive anterior wall infarction.

Context: Legionella pneumonia can rarely present with extrapulmonary complications, including the triad of rhabdomyolysis, transaminitis, and acute kidney injury. Early recognition of this triad is critical to initiate early treatment to reduce complications. Report of Case: A 47-year-old woman with asthma, chronic anemia, hypertension, and schizoaffective disorder presented with fever, chills, abdominal pain, nausea, vomiting, and a nonproductive cough. She had recently been residing in a women’s shelter cooled by window air conditioning units. Laboratory evaluation revealed acute kidney injury, elevated liver transaminases, and markedly elevated creatine kinase. Chest radiography was consistent with pneumonia. Empiric intravenous ceftriaxone and azithromycin were initiated. Emergent hemodialysis was also required for worsening renal function. Extensive infectious and autoimmune testing was performed. Urinary antigen and serologic testing confirmed Legionella pneumophila infection. Hemophagocytic lymphohistiocytosis was considered due to a high predictive score, prompting a bone marrow biopsy, which was

unremarkable. The patient completed a 19-day course of antibiotics, received hemodialysis during hospitalization, and was discharged with improving renal function. Conclusion: This case demonstrates the rare extrapulmonary manifestations of Legionella pneumonia, specifically the triad of rhabdomyolysis, transaminitis, and acute kidney injury. A literature review was performed using PubMed with the search terms “Legionella pneumonia,” “rhabdomyolysis,” and “acute kidney injury.” Most previously reported cases describe older patients or those with significant comorbidities. In contrast our patient was middle-aged with relatively well-controlled chronic conditions. While the majority of cases responded to antibiotics alone, this patient required emergent hemodialysis, highlighting the potential severity of renal involvement. This comparison emphasizes the need for clinicians to recognize this triad early and initiate prompt antimicrobial therapy.

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2026 Research Recognition Day