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Matthys I, Borsboom D, Steyaert S, Vervloet D, Cornelis K, Vanderstraeten E, Kindt S, Dewint P, Lambrecht V, Sinnaeve P, Van Steenkiste C. A plethora of manifestations following a Mycoplasma pneumoniae infection: a case report. Acta Clin Belg 2020; 75:229-234. [PMID: 30767713 DOI: 10.1080/17843286.2019.1578029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Mycoplasma pneumoniae infection can present with a plethora of symptoms and result in a systemic vasculitis by activating a cascade of autoimmune reactions. In this case report, a young man without relevant past medical history was admitted to the hospital with diarrhea, abdominal pain and spiking fever. A CT-scan showed terminal ileitis. A 5-day broad spectrum antibiotic treatment (ciprofloxacin/clindamycin) did not result in any clinical improvement. On the contrary, the patient developed a cholestatic hepatitis, bilateral anterior uveitis and a dry cough. Extensive serological testing finally led to the diagnosis of a M. pneumoniae infection by paired serology (≥4-fold rise in IgG titer). In the diagnostic work-up, a PET-CT was performed and showed increased tracer uptake in the carotids and vertebral arteries, suggesting the diagnosis of vasculitis. After start of azithromycin and low-dose corticosteroids (0.5 mg/kg/day), a gradual clinical and biochemical improvement was observed. But subsequently, the patients relapsed and presented with an acute coronary syndrome. Coronary angiography revealed aneurysmatic deformation of the three coronary arteries, leading to the assumption of coronary vasculitis. Clinical improvement was achieved with high-dose corticosteroids (1 mg/kg/day). This case shows that M. pneumoniae is not merely a pulmonary infection, but that its primary symptoms can be diverse and misleading. All clinicians should be aware of its extrapulmonary manifestations.
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Affiliation(s)
- Imke Matthys
- Departement of Internal Medicine, Universitair Ziekenhuis, Gent, Belgium
| | - Daniel Borsboom
- Department of Internal Medicine, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Sophia Steyaert
- Department of Microbiology, AZ Maria Middelares, Ghent, Belgium
| | | | | | | | - Sébastien Kindt
- Department of Gastroenteroly, AZ Maria Middelares, Ghent, Belgium
| | - Pieter Dewint
- Department of Gastroenteroly, AZ Maria Middelares, Ghent, Belgium
| | | | - Peter Sinnaeve
- Department of Cardiology, Universitair ziekenhuis Leuven, Leuven, Belgium
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Jujaray D, Juan LZ, Shrestha S, Ballgobin A. Pattern and Significance of Asymptomatic Elevation of Liver Enzymes in Mycoplasma Pneumonia in Children. Clin Pediatr (Phila) 2018; 57:57-61. [PMID: 28155329 DOI: 10.1177/0009922816688737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mycoplasma infection is on the rise in recent times. It usually infects any system, including liver. This study aims to show the significance of elevated liver enzymes in mycoplasma pneumonia and to have a look at future prospects. This is a single-center retrospective study involving 105 children serologically positive for mycoplasma IgM and IgG antibodies and 50 with community-acquired pneumonia caused by organisms other than mycoplasma and Epstein-Barr virus from June 2015 to June 2016 and all without prior liver disease. The patients were followed after 10 days (7-14 days). The liver enzymes were significantly elevated in Mycoplasma pneumoniae infection. The mean levels of alanine transaminase and aspartate transaminase were 39.3 and 32.5 IU/L, respectively. There was a seasonal variation during the months of September and February. Liver involvement in mycoplasma pneumonia is mostly a benign condition and asymptomatic. It is insisted that children with continued elevation should be followed conservatively to avoid unnecessary diagnostic procedures in the future.
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Affiliation(s)
- Deepti Jujaray
- 1 Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liu Zheng Juan
- 1 Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shraddha Shrestha
- 2 First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ashiana Ballgobin
- 1 Second Affiliated Hospital of Dalian Medical University, Dalian, China
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Shen Y, Zhang J, Hu Y, Shen K. Combination therapy with immune-modulators and moxifloxacin on fulminant macrolide-resistant Mycoplasma pneumoniae infection: A case report. Pediatr Pulmonol 2013; 48:519-22. [PMID: 22949411 DOI: 10.1002/ppul.22650] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 06/28/2012] [Indexed: 12/17/2022]
Abstract
This report entails a case of refractory pneumonia with a wild variety of extra-pulmonary manifestations due to macrolide-resistant Mycoplasma pneumoniae infection in a 7-year-old boy. The diagnosis was based on isolating M. pneumoniae through cultivation from the patient's bronchial aspirations at admission and the following susceptibility testing. Initial treatments consisting of a combination of azithromycin and standard-dosed methylprednisone (2 mg/kg) were completely nonresponsive and the patient's condition deteriorated rapidly. However, methylprednisone pulse therapy (20 mg/kg for 3 days, tapering within 1 month) and intravenous immunoglobulin (1 g/kg/day, two doses), in addition to moxifloxacin (10 mg/kg for 7 days) were remarkably effective and led to a favorable outcome without any observed side effects during inpatient hospitalization and outpatient follow-up.
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Affiliation(s)
- Yuelin Shen
- Respiratory Department, Beijing Children's Hospital, Capital Medical University, Beijing, People's Republic of China
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Kunimi Y, Hirata Y, Aihara M, Yamane Y, Ikezawa Z. Statistical analysis of Stevens-Johnson syndrome caused by Mycoplasma pneumonia infection in Japan. Allergol Int 2011; 60:525-32. [PMID: 22113160 DOI: 10.2332/allergolint.11-oa-0309] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/31/2011] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) associated with Mycoplasma pneumoniae (M. pneumoniae) infection is mainly observed in children. In adults, drugs are a major cause of SJS, but some adult patients with SJS are infected with M. pneumoniae. We analyzed patients with SJS associated with M. pneumoniae infection to elucidate the differences between drug-induced SJS and M. pneumoniae-associated SJS and also to study differences between M. pneumoniae-associated SJS in children and adults. METHODS This is a retrospective review of Japanese patients who have been reported as M. pneumoniae-associated SJS in medical Journals published from 1981 to 2009, compared with data of Japanese patients with drug-induced SJS reported from 2000 to 2009. RESULTS Thirty-eight cases of M. pneumoniae-associated SJS and 78 cases of drug-induced SJS were analyzed in this study. Ocular lesions were observed more frequently in M. pneumoniae-associated SJS than in drug-induced SJS (p < 0.01), and adult patients showed a higher ratio of sequelae in their eyes than did patients under 20 years of age (p < 0.01). Sixty-six percent of adult patients with M. pneumoniae-associated SJS developed fever/respiratory symptoms and mucocutaneous lesions on the same day. In contrast, most of the patients under 20 years of age developed fever/respiratory symptoms before mucocutaneous involvement. This means that these adult patients were infected and immunized previously and developed allergic reactions to M. pneumoniae soon after the later infection. CONCLUSIONS In order to prevent ocular sequelae in adult patients when M. pneumoniae infection is suspected, more intensive treatment may be needed in adult patients than in younger patients.
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Affiliation(s)
- Yuko Kunimi
- Department of Immuno-dermatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan.
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5
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Abstract
Mycoplasma pneumonia is a common respiratory pathogen that produces diseases of varied severity ranging from mild upper respiratory tract infection to severe atypical pneumonia. Apart from respiratory tract infections, this organism is also responsible for producing a wide spectrum of non-pulmonary manifestations including neurological, hepatic, cardiac diseases, hemolytic anemia, polyarthritis and erythema multiforme. This review focuses on molecular taxonomy, biological characteristics, epidemiology, clinical presentation, radiology and various laboratory tools in diagnosis, differential diagnosis, treatment and prevention of mycoplasma pneumonia.
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Affiliation(s)
- Surender Kashyap
- Department of Pulmonary, Indira Gandhi Medical College, Shimla, India
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Murayama A, Abukawa D, Watanabe K, Umebayashi H, Inagaki T, Miura K, Takeyama J. Severe liver dysfunction in patients with Mycoplasma pneumoniae infection. Pediatr Int 2010; 52:e105-7. [PMID: 20500455 DOI: 10.1111/j.1442-200x.2010.03084.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Akitoshi Murayama
- Department of General Pediatrics, Miyagi Children's Hospital, 4-3-17 Ochiai, Aoba-ku, Sendai, Miyagi 989-3126, Japan.
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7
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Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010; 16:162-9. [DOI: 10.1007/s10156-010-0044-x] [Citation(s) in RCA: 156] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2009] [Indexed: 12/30/2022]
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Chang JH, Kwon YS, Kim BK, Son BK, Lee JE, Lim DH, Kim SK, Kim JM, Kang SK. A case of acute hepatitis with Mycoplasma pneumoniae infection and transient depression of multiple coagulation factors. Yonsei Med J 2008; 49:1055-9. [PMID: 19108034 PMCID: PMC2628021 DOI: 10.3349/ymj.2008.49.6.1055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depression of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normalization of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection.
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Affiliation(s)
- Joo Hee Chang
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Young Se Kwon
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Bok Ki Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Byong Kwan Son
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Jee Eun Lee
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Dae Hyun Lim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Soon Ki Kim
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
| | - Joon Mi Kim
- Department of Pathology, Inha University College of Medicine, Incheon, Korea
| | - Sung Kil Kang
- Department of Pediatrics, Inha University College of Medicine, Incheon, Korea
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Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005; 51:343-54. [PMID: 16181677 DOI: 10.1016/j.jinf.2005.07.005] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2005] [Accepted: 07/23/2005] [Indexed: 11/27/2022]
Abstract
Mycoplasma pneumoniae infection is associated with several manifestations from the central nervous system (CNS) such as encephalitis, aseptic meningitis, acute transverse myelitis, stroke, and polyradiculopathy. In the current paper epidemiologic, clinical, laboratory and treatment data on these manifestations are reviewed. The M. pneumoniae induced immune dysregulation and its contributing role in the pathogenesis of neurological insult is discussed. The recent introduction in clinical practice of newer molecular diagnostic techniques has helped in establishing a firmer association between M. pneumoniae infection and CNS disease especially encephalitis. Clinicians should be aware of the potential association between M. pneumoniae infection and several CNS manifestations. The role of various anti-microbial or immunomodulating therapies in treating such manifestations should be further explored.
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Affiliation(s)
- S Tsiodras
- 4th Academic Department of Internal Medicine and Infectious Diseases, Attikon University Hospital, University of Athens Medical School, 1 Rimini Street, Xaidari, 12462 Athens, Greece.
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Daxboeck F, Gattringer R, Mustafa S, Bauer C, Assadian O. Elevated serum alanine aminotransferase (ALT) levels in patients with serologically verified Mycoplasma pneumoniae pneumonia. Clin Microbiol Infect 2005; 11:507-10. [PMID: 15882205 DOI: 10.1111/j.1469-0691.2005.01154.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The possibility of liver involvement in Mycoplasma pneumoniae pneumonia is still controversial. This study investigated 33 adult patients with serologically confirmed M. pneumoniae community-acquired pneumonia (CAP) (median age 31 years) and 38 patients with bacteraemic Streptococcus pneumoniae CAP (median age 54 years), all without pre-existing liver disease. Serum alanine aminotransferase (ALT) levels were elevated in 12 (36.4%) patients with M. pneumoniae CAP (median 53.5 U/L), and in four (10.5%) patients with S. pneumoniae CAP (median 61 U/L) (p 0.025). In most patients with M. pneumoniae CAP, the elevated ALT levels decreased during macrolide therapy, although this decrease was not significant.
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Affiliation(s)
- F Daxboeck
- Clinical Institute of Hygiene and Medical Microbiology, Division of Hospital Hygiene, Medical University Vienna, Vienna General Hospital, Vienna, Austria.
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