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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.

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