DOI: 10.4103/ipcares.ipcares_96_26 ISSN: 2772-5170

Mycoplasma Pneumoniae Infection with Life-Threatening Immune-Mediated Multi-System Involvement: A Case Report

Swagata Karan, Madiha Zainab, Kaushik Maulik, Prabhas Prasun Giri, Agnisekhar Saha
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Abstract

Background:

Mycoplasma pneumoniae is a frequent cause of community-acquired pneumonia in children, but disseminated disease involving the central nervous system, musculoskeletal system, and pleuropulmonary structure is rare.

Clinical Description:

A 5-year-old boy presented with an acute onset of high-grade intermittent fever, cough, and progressive respiratory distress. On admission, he was in an altered sensorium with severe hypoxemia and right-sided pleural effusion. There were no signs of meningism and no focal neurological deficit.

Management and Outcome:

Despite empirical broad-spectrum antibiotics and intercostal drainage, his respiratory status worsened, necessitating invasive mechanical ventilation. He developed recurrent seizures, with magnetic resonance imaging of the brain suggestive of meningoencephalitis. Pleural fluid was lymphocyte-predominant exudative and culture-negative. M. pneumoniae Immunoglobulin M (IgM) was positive in blood, but the clinical condition was refractory to doxycycline. Considering an immune-mediated hyper-inflammatory phenomenon, intravenous methylprednisolone was administered, which resulted in marked clinical improvement. The child subsequently developed transient reactive arthritis of the right hip, which responded to ibuprofen. Later, at follow-up, there was more than a 4-fold rise in M. pneumoniae IgM titer, thus confirming Mycoplasma infection.

Conclusion:

This case highlights the potential for M. pneumoniae to cause life-threatening extrapulmonary disease in children. Early recognition, initiation of doxycycline, and timely use of corticosteroids in selected cases with severe inflammation with multiorgan dysfunction are critical for favorable outcomes.

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