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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.<\/jats:p>","DOI":"10.1136\/bcr-2021-243023","type":"journal-article","created":{"date-parts":[[2021,8,3]],"date-time":"2021-08-03T11:51:29Z","timestamp":1627991489000},"page":"e243023","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Complement-mediated autoimmune haemolytic anaemia as an initial presentation of Legionnaires\u2019 disease"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3910-1349","authenticated-orcid":false,"given":"Uzma","family":"Sabahat","sequence":"first","affiliation":[{"name":"Internal Medicine, Rashid Hospital, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niaz Ahmed","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Internal Medicine, Rashid Hospital, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali Mohammed Mahmood","family":"Alameen","sequence":"additional","affiliation":[{"name":"Pathology, Rashid Hospital, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Faryal","family":"Ashfaq","sequence":"additional","affiliation":[{"name":"Internal Medicine, Rashid Hospital, Dubai, UAE"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,3]]},"reference":[{"key":"2025082700411850000_14.8.e243023.1","unstructured":"Tsai TF , Finn DR , Plikaytis BD , et al . 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