Severe psittacosis complicated by rhabdomyolysis, acute kidney injury, and upper gastrointestinal hemorrhage: A case report

OBJECTIVES: Psittacosis, caused by Chlamydia psittaci, typically presents as atypical pneumonia. This report details a severe case characterized by rapid, sequential multi-organ failure, highlighting a life-threatening clinical spectrum beyond conventional respiratory manifestations. CASE PRESENTATION: We present the case of a 62-year-old man admitted with fever, cough, and lower limb weakness. Following an initial lack of response to broad-spectrum antibiotics, he developed rapidly progressive rhabdomyolysis, acute kidney injury requiring hemodialysis, and upper gastrointestinal hemorrhage. Further epidemiological inquiry revealed a history of close contact with parrots ten days prior to symptom onset, a crucial clue that guided the targeted molecular diagnosis of psittacosis. RESULTS: Routine pathogen tests were negative. Targeted next-generation sequencing (tNGS) of sputum detected 55,825 sequence reads specific to C. psittaci, confirming the diagnosis. The patient was switched to targeted therapy with minocycline. With supportive care including renal replacement therapy, his clinical and laboratory parameters improved significantly, and he was eventually discharged in stable condition. CONCLUSIONS: This case underscores that psittacosis can precipitate rapid, sequential multi-organ failure. For severe, rapidly progressive pneumonia with extrapulmonary complications and negative conventional tests, psittacosis should be considered. tNGS is a pivotal tool for rapid diagnosis, enabling timely shift to targeted therapy. Successful management requires an integrated strategy combining precise antimicrobials and aggressive multi-organ support.