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

Abstract

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.

Keywords: Lupus flare; Mycoplasma pneumoniae; Parapneumonic effusion.

Fig. 1

A: Chest X-ray on day 1 showing bilateral pleural effusion. Fig 1B: Chest X-ray on day 30 showing complete resolution of pleural effusion.

Fig. 2

: A: Ultrasound image showing loculated pleural effusion. Fig 2B: Yellow, turbid, pleural fluid.

Fig. 3

A: CT scan of the chest on day 1 showing loculated pleural effusion. Fig 3B: CT scan of the chest on day 7 showing improvement in loculated effusion after intrapleural fibrinolytic therapy. Fig 3C: CT scan of the chest on day 30 showing complete resolution of pleural effusion.

Fig. 4

(A) Light microscopy showing endocapillary proliferation with widespread ‘wire loop’ appearance in the glomerular capillary wall. (B)Histologic examination of tubular changes showing evidence of acute tubular necrosis and edema. (C) Light microscopy showing active crescent. (D) Immunofluorescence micrograph showing diffuse and globally distributed granular IgG deposits in the glomerular capillary walls.