Central retinal artery occlusion and cerebral infarction associated with Mycoplasma pneumonia infection in children

Abstract

Background: Central retinal artery occlusion (CRAO) is an arterial ischemic stroke, rarely occurred in children accompanied with asymptomatic cerebral infarction and almost never involved in severe pneumonia related to Mycoplasma pneumonia infection.

Case presentation: An 8-year-old boy with severe pneumonia related to Mycoplasma pneumonia infection that developed loss of vision in the left eye on the 14^th day. No light perception and no pupillary reaction to light were found in the left eye. The fundus examination revealed a cherry red spot with severe retinal edema at the macular and peripapillary area, and the optic disc was pale in the left eye but normal in the right eye, suggesting CRAO in the left eye. No obvious neurological symptoms and signs were observed on presentation. Magnetic resonance imaging of the brain showed an abnormal signal of the left lentiform nucleus, caudate nucleus and within the temporal lobe, suggesting an acute cerebral infarction. The analysis of cerebrospinal fluid showed an increasing leukocyte count, but no any pathogenic microorganisms were found. His respiratory symptoms disappeared promptly after therapy, and the patient was discharged after 11 days later, but there was no light in the left eye 2 months after discharge.

Conclusion: M. pneumoniae infection could be developed the risk for cerebral ischemic stroke, including CRAO in children with severe pneumonia. CRAO is a devastating ophthalmologic event leading to a severe impairment of vision. Patients treated within about 6 h of vision loss had a better visual outcome after the onset of vision loss.

Keywords: Brain infarction; Central retinal artery occlusion; Children; Mycopasma pneumonia; Pneumonia.

Fig. 1

a Chest X-ray showed that two lung markings were increased, the high density lower right lung patchy shadows and a small right-sided pleural effusion at the initial presentation. b Chest X-ray showed that two lung textures were increased, the right lower lung had a high patchy density, and its edge was smooth. The right rib diaphragm angle was lost. The heart shadow had no obvious increase, and the left diaphragm was normal on the second day after transfer

Fig. 2

Chest CT: Large high-intensity lesions in his right lower lung lobe, the stenosis of the lower right bronchial lumen and right-sided pleural effusion at the initial presentation

Fig. 3

a-b Magnetic resonance imaging (MRI) of the brain showed a T2W1-weighted high-intensity signal (a) and a T1W1-weighted low-intensity signal of the left lentiform nucleus, caudate nucleus and temporal lobe (b), suggesting an acute infarction of the brain, including the above regions the first day after transfer

Fig. 4

Fundus examination showed that the optic disc on the left eye was clear and pale, C/D = 0.3. The central retinal artery was sclerosed, the retina was normal, but the macular pigment was severely disordered at the 2-month follow-up after CRAO