Severe Sepsis With Septic Shock as a Consequence of a Severe Community-Acquired Pneumonia Resulting From a Combined Legionella pneumophila and Streptococcus pneumoniae Infection

Community-acquired pneumonia (CAP) is a frequent cause of intensive care unit (ICU) admission in adults and the sixth leading cause of death worldwide. Although co-infections have been previously reported, the co-existence of Streptococcus pneumoniae and Legionella pneumophila is exceedingly rare. Despite the fact that Streptococcus pneumoniae is the most common etiology in the majority of cases, atypical organisms such as Legionella pneumophila should be considered as etiologic agents among all CAP cases that require hospitalization. Unlike Legionella, extra-pulmonary findings are uncommon in patients with Streptococcus pneumoniae pneumonia. In this report, the authors describe an unusual case of septic shock resulting from a combined Legionella pneumophila and Streptococcus pneumoniae infection associated with rhabdomyolysis, acute kidney injury, acute hypoxemic respiratory failure, pancreatitis, and acute liver injury.