Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires’ disease
A 42-year-old diabetic man presented to the hospital with severe sepsis and multiorgan dysfunction. A probable respiratory source of sepsis was suspected because of suggestive clinical and radiological findings. He was critically ill and was therefore admitted to intensive care for further managemen...
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description | A 42-year-old diabetic man presented to the hospital with severe sepsis and multiorgan dysfunction. A probable respiratory source of sepsis was suspected because of suggestive clinical and radiological findings. He was critically ill and was therefore admitted to intensive care for further management including ventilatory support and renal replacement therapy. He was also found to have marked anaemia requiring multiple blood transfusions with clinical and laboratory evidence pointing towards severe haemolysis. Further workup for the aetiology of pneumonia established a diagnosis of Legionella by confirmatory tests namely legionella antigen in the urine and exponentially rising serum antibody titres. The cause for the severe haemolysis was found to be complement-mediated autoimmune haemolysis as determined by direct antiglobulin test positive for complement components C3 and negative for IgG. Such clinically significant autoimmune haemolysis as a presenting feature, rather than a late complication, has never before been reported in the literature. |
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A probable respiratory source of sepsis was suspected because of suggestive clinical and radiological findings. He was critically ill and was therefore admitted to intensive care for further management including ventilatory support and renal replacement therapy. He was also found to have marked anaemia requiring multiple blood transfusions with clinical and laboratory evidence pointing towards severe haemolysis. Further workup for the aetiology of pneumonia established a diagnosis of Legionella by confirmatory tests namely legionella antigen in the urine and exponentially rising serum antibody titres. The cause for the severe haemolysis was found to be complement-mediated autoimmune haemolysis as determined by direct antiglobulin test positive for complement components C3 and negative for IgG. Such clinically significant autoimmune haemolysis as a presenting feature, rather than a late complication, has never before been reported in the literature.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2021-243023</identifier><identifier>PMID: 34344647</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Abdomen ; Adult ; Anemia ; Anemia, Hemolytic, Autoimmune - complications ; Anemia, Hemolytic, Autoimmune - diagnosis ; Anemia, Hemolytic, Autoimmune - therapy ; Antibiotics ; Antibodies ; Antigens ; Arthritis ; Bacterial infections ; Blood transfusions ; Case Report ; Case reports ; Cold ; Complement C3 ; Cytomegalovirus ; Dehydrogenases ; Disease ; Emergency medical care ; Hemoglobin ; Hemolysis ; Hepatitis C ; Hospitalization ; Hospitals ; Humans ; Infections ; Intensive care ; Laboratories ; Legionnaires' disease ; Legionnaires' Disease - complications ; Legionnaires' Disease - diagnosis ; Male ; Pneumonia ; Sepsis ; Tuberculosis ; Urine</subject><ispartof>BMJ case reports, 2021-08, Vol.14 (8), p.e243023</ispartof><rights>BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ. 2021</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b415t-bd80fe895b634e628e19ab12d5929f725ed1702da55668ebb9a4e7727f4e28083</citedby><cites>FETCH-LOGICAL-b415t-bd80fe895b634e628e19ab12d5929f725ed1702da55668ebb9a4e7727f4e28083</cites><orcidid>0000-0002-3910-1349</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336222/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8336222/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34344647$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sabahat, Uzma</creatorcontrib><creatorcontrib>Shaikh, Niaz Ahmed</creatorcontrib><creatorcontrib>Alameen, Ali Mohammed Mahmood</creatorcontrib><creatorcontrib>Ashfaq, Faryal</creatorcontrib><title>Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires’ disease</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>A 42-year-old diabetic man presented to the hospital with severe sepsis and multiorgan dysfunction. A probable respiratory source of sepsis was suspected because of suggestive clinical and radiological findings. He was critically ill and was therefore admitted to intensive care for further management including ventilatory support and renal replacement therapy. He was also found to have marked anaemia requiring multiple blood transfusions with clinical and laboratory evidence pointing towards severe haemolysis. Further workup for the aetiology of pneumonia established a diagnosis of Legionella by confirmatory tests namely legionella antigen in the urine and exponentially rising serum antibody titres. The cause for the severe haemolysis was found to be complement-mediated autoimmune haemolysis as determined by direct antiglobulin test positive for complement components C3 and negative for IgG. Such clinically significant autoimmune haemolysis as a presenting feature, rather than a late complication, has never before been reported in the literature.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Anemia</subject><subject>Anemia, Hemolytic, Autoimmune - complications</subject><subject>Anemia, Hemolytic, Autoimmune - diagnosis</subject><subject>Anemia, Hemolytic, Autoimmune - therapy</subject><subject>Antibiotics</subject><subject>Antibodies</subject><subject>Antigens</subject><subject>Arthritis</subject><subject>Bacterial infections</subject><subject>Blood transfusions</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Cold</subject><subject>Complement C3</subject><subject>Cytomegalovirus</subject><subject>Dehydrogenases</subject><subject>Disease</subject><subject>Emergency medical care</subject><subject>Hemoglobin</subject><subject>Hemolysis</subject><subject>Hepatitis C</subject><subject>Hospitalization</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Infections</subject><subject>Intensive care</subject><subject>Laboratories</subject><subject>Legionnaires' disease</subject><subject>Legionnaires' Disease - complications</subject><subject>Legionnaires' Disease - diagnosis</subject><subject>Male</subject><subject>Pneumonia</subject><subject>Sepsis</subject><subject>Tuberculosis</subject><subject>Urine</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkc2KFDEUhYMozjDO2p0E3IhQTv6T2gjS-AcNbhTchaTqVk-aStImVcLsfA1fzycxTY_D6MZscki-e-69HISeUvKKUq6u_FA6RhjtmOCE8QfonGqpO92Trw_v6TN0WeuetMOpMII_RmdccCGU0Odot8nxMEOEtHQRxuAWGLFblxxiXBPgawcxzzdLGLBLTQeHXW0ShxSW4GZ8KFBbsVtCTjhPeAu7ppIL7f3Xj594DBVchSfo0eTmCpe39wX68u7t582Hbvvp_cfNm23nBZVL50dDJjC99IoLUMwA7Z2nbJQ96yfNJIxUEzY6KZUy4H3vBGjN9CSAGWL4BXp98j2svu0ztNGKm-2hhOjKjc0u2L9_Uri2u_zdGs4VY6wZvLg1KPnbCnWxMdQB5tklyGu1TMrWx_D-2Ov5P-g-ryW19Y6U1lxxJRp1daKGkmstMN0NQ4k95mhbjvaYoz3l2Cqe3d_hjv-TWgNengAf9_91-w3YWKi4</recordid><startdate>20210803</startdate><enddate>20210803</enddate><creator>Sabahat, Uzma</creator><creator>Shaikh, Niaz Ahmed</creator><creator>Alameen, Ali Mohammed Mahmood</creator><creator>Ashfaq, Faryal</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3910-1349</orcidid></search><sort><creationdate>20210803</creationdate><title>Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires’ disease</title><author>Sabahat, Uzma ; Shaikh, Niaz Ahmed ; Alameen, Ali Mohammed Mahmood ; Ashfaq, Faryal</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b415t-bd80fe895b634e628e19ab12d5929f725ed1702da55668ebb9a4e7727f4e28083</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Anemia</topic><topic>Anemia, Hemolytic, Autoimmune - complications</topic><topic>Anemia, Hemolytic, Autoimmune - diagnosis</topic><topic>Anemia, Hemolytic, Autoimmune - therapy</topic><topic>Antibiotics</topic><topic>Antibodies</topic><topic>Antigens</topic><topic>Arthritis</topic><topic>Bacterial infections</topic><topic>Blood transfusions</topic><topic>Case Report</topic><topic>Case reports</topic><topic>Cold</topic><topic>Complement C3</topic><topic>Cytomegalovirus</topic><topic>Dehydrogenases</topic><topic>Disease</topic><topic>Emergency medical care</topic><topic>Hemoglobin</topic><topic>Hemolysis</topic><topic>Hepatitis C</topic><topic>Hospitalization</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Infections</topic><topic>Intensive care</topic><topic>Laboratories</topic><topic>Legionnaires' disease</topic><topic>Legionnaires' Disease - complications</topic><topic>Legionnaires' Disease - diagnosis</topic><topic>Male</topic><topic>Pneumonia</topic><topic>Sepsis</topic><topic>Tuberculosis</topic><topic>Urine</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sabahat, Uzma</creatorcontrib><creatorcontrib>Shaikh, Niaz Ahmed</creatorcontrib><creatorcontrib>Alameen, Ali Mohammed Mahmood</creatorcontrib><creatorcontrib>Ashfaq, Faryal</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sabahat, Uzma</au><au>Shaikh, Niaz Ahmed</au><au>Alameen, Ali Mohammed Mahmood</au><au>Ashfaq, Faryal</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires’ disease</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2021-08-03</date><risdate>2021</risdate><volume>14</volume><issue>8</issue><spage>e243023</spage><pages>e243023-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>A 42-year-old diabetic man presented to the hospital with severe sepsis and multiorgan dysfunction. A probable respiratory source of sepsis was suspected because of suggestive clinical and radiological findings. He was critically ill and was therefore admitted to intensive care for further management including ventilatory support and renal replacement therapy. He was also found to have marked anaemia requiring multiple blood transfusions with clinical and laboratory evidence pointing towards severe haemolysis. Further workup for the aetiology of pneumonia established a diagnosis of Legionella by confirmatory tests namely legionella antigen in the urine and exponentially rising serum antibody titres. The cause for the severe haemolysis was found to be complement-mediated autoimmune haemolysis as determined by direct antiglobulin test positive for complement components C3 and negative for IgG. Such clinically significant autoimmune haemolysis as a presenting feature, rather than a late complication, has never before been reported in the literature.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>34344647</pmid><doi>10.1136/bcr-2021-243023</doi><orcidid>https://orcid.org/0000-0002-3910-1349</orcidid></addata></record> |
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subjects | Abdomen Adult Anemia Anemia, Hemolytic, Autoimmune - complications Anemia, Hemolytic, Autoimmune - diagnosis Anemia, Hemolytic, Autoimmune - therapy Antibiotics Antibodies Antigens Arthritis Bacterial infections Blood transfusions Case Report Case reports Cold Complement C3 Cytomegalovirus Dehydrogenases Disease Emergency medical care Hemoglobin Hemolysis Hepatitis C Hospitalization Hospitals Humans Infections Intensive care Laboratories Legionnaires' disease Legionnaires' Disease - complications Legionnaires' Disease - diagnosis Male Pneumonia Sepsis Tuberculosis Urine |
title | Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires’ disease |
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