Effects of Methylprednisolone Pulse Therapy on Refractory Mycoplasma pneumoniae Pneumonia in Children

Abstract

Purpose: Mycoplasma pneumoniae (M. pneumoniae) is one of the most common causes of community-acquired pneumonia in children. The clinical course is typically self-limited and benign; however, rare cases of severe pneumonia can develop despite appropriate antibiotic therapy. We studied the effects of methylprednisolone pulse therapy on severe refractory M. pneumoniae pneumonia in children.

Methods: The clinical effects of methylprednisolone therapy were evaluated retrospectively in 12 children with severe refractory M. pneumoniae pneumonia, which was diagnosed serologically. All patients developed respiratory distress, high fever, and initial lobar pneumonic consolidation based on radiological findings. All clinical symptoms deteriorated despite appropriate antibiotic therapy. Thus, children were treated with intravenous methylprednisolone pulse therapy in addition to antibiotics.

Results: The average febrile period before admission was 4.9±1.7 days, and fever persisted in all children until steroid administration. Methylprednisolone pulse therapy (30 mg/kg) was given 5.4±2.5 days after admission. After methylprednisolone pulse therapy, clinical symptoms improved in all patients without adverse events. The fever subsided 0-2 h after initiation of corticosteroid therapy. The abnormal radiological findings resolved within 2.6±1.3 days, and the high C-reactive protein levels (6.7±5.9 mg/dL) on admission decreased to 1.3±1.7 mg/dL within 3.0±1.1 days after starting corticosteroid therapy.

Conclusions: Three-day methylprednisolone pulse therapy could be applied to treatment of refractory M. pneumoniae pneumonia despite appropriate antibiotic therapy and appeared to be efficacious and well-tolerated.

Keywords: Children; Mycoplasma pneumoniae; methylprednisolone; pneumonia.

Fig. 1

Defervescence was observed in all children after methylprednisolone pulse therapy. (A) Body temperature data were analyzed using repeated-measures ANOVA (P<0.001). (B) Decreasing serum CRP levels were observed in all children after methylprednisolone pulse therapy. CRP concentrations were analyzed using repeated-measures ANOVA (P<0.001). ^*The one day before admission. ^†The day on admission. ^‡The first day of admission. ^§The second day of admission. ^∥The third day of admission. ^¶The 4.3±2.3 day of admission (before steroid pulse therapy). ^**The 8.3±2.0 day of admission (after steroid pulse therapy). CRP, C-reactive protein; HD, hospital day.

Fig. 2

Chest radiographs of patient 4. (A) Chest radiography upon admission showed consolidation of the left lower lobe with pleural effusion. (B) Before methylprednisolone pulse therapy, the radiographic findings remained unchanged with deteriorated clinical signs at hospital day 3. (C) Chest radiography showed resolution of consolidation of the left lower lobe and decreased pleural effusion on the day after initiation of methylprednisolone pulse therapy at hospital day 4. (D) hospital day 7.