A Rare Case of Cavitary Lesion of the Lung Caused by Mycoplasma pneumoniae in an Immunocompetent Patient

Mycoplasma pneumoniae and Bronchiolitis Obliterans: How a Common Organism Leads to a Rare Pulmonary Disease in Pediatrics

A rare lung disease, bronchiolitis obliterans (BO) is characterized by airway obstruction and fibrosis of the terminal and respiratory bronchioles. It usually occurs after lung and bone marrow transplants, hematopoietic stem cell transplantation (HSCT), inhalation of toxins, respiratory infections, or in association with several different connective tissue or irritable bowel diseases. When BO is caused by an infection it is referred to as post-infectious bronchiolitis obliterans (PIBO). The prevalence of BO is unknown but has been seen to occur worldwide. The pathophysiology of BO is not fully understood but there is evidence of fibroproliferation leading to abnormal airway remodeling with inflammatory mediators and granulation tissue that narrows the bronchial lumen. Diagnosis of BO is achieved via a combination of clinical manifestations, patient history, pulmonary function test (PFT), radiological imaging, and lung biopsy as the gold standard. Since there is limited literature on pediatric cases with BO and diagnosis may sometimes be challenging, we aim to bring awareness to a pediatric case where PIBO developed after a common pulmonary infection of Mycoplasma pneumoniae.

A 21-Year-Old Immunocompetent Man With Hemoptysis and Rash

CASE PRESENTATION

A 21-year-old man presented to the ED of The George Washington University Hospital complaining of chills, shortness of breath, hemoptysis, and a generalized rash. Three days before admission, he noticed a productive cough, severe sore throat, and subjective fever. He also experienced extreme fatigue, generalized sweating, and chest pain with coughing. On the day before admission, he experienced a nonpruritic rash on his neck, palms, and dorsal surfaces of his feet and sputum with streaks of blood. The patient had no significant medical or family history. He had no sick contacts, and his only recent travel was to an outdoor concert in a woody area of the northeastern United States about a month earlier. He did not report recent contact with birds or visits to caves. He is single, lives alone in an apartment, and consumes about 4 alcoholic beverages a week. Occasionally, he smokes cannabis and e-cigarettes. He is sexually active with men, and his last unprotected sexual encounter was a month earlier. He denied photophobia, rhinorrhea, ear pain, nasal congestion, abdominal pain, nausea, vomiting, diarrhea, or dysuria.

Rare complicated parapneumonic effusion, Mycoplasma pneumoniae with new-onset lupus flare: Case report and literature review

Mycoplasma pneumoniae has been associated with respiratory tract infections. Mycoplasma pneumoniae pneumonia–related pleural effusion is rarely reported. Extra-pulmonary abnormalities such as encephalitis, myocarditis, glomerulonephritis, and myringitis have been reported. However pulmonary manifestations in systemic lupus erythematosus include pneumonitis, pleurisy, interstitial lung disease, and thromboembolic disease. We present the case of a 26-year-old male who came for evaluation of fever, cough, and shortness of breath with right-sided chest pain. He was found to have right-side loculated complicated parapneumonic effusion and underwent drainage with a pleural catheter followed by fibrinolytic therapy. He was then found to have new-onset systemic lupus erythematosus concomitant with Mycoplasma pneumonia, leading to lupus flare and lupus nephritis. He responded well to levofloxacin, steroids, hydroxychloroquine, and mycophenolate, with complete resolution of loculated pleural effusion and symptom improvement. Our case describes the rare combination of Mycoplasma pneumoniae pneumonia, parapneumonic pleural effusion, and lupus flare with lupus nephritis. Early identification and treatment can lead to better out come in young patients.