Refractory Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction in a child: A case report and literature review

Abstract

Rationale: Mycoplasma pneumoniae pneumonia, a common cause of community-acquired pneumonia in children, is rarely complicated with acute cerebral infarction.

Patient concerns: We present a 7-year-old boy with severe M pneumoniae pneumonia who developed impaired consciousness, aphasia, and reduced limb muscle power 7 days postadmission.

Diagnoses: Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction.

Interventions: The patient recovered with aggressive antibiotic therapy, antiinflammation therapy with methylprednisolone, and gamma immunoglobulin and anticoagulation therapy with aspirin and low molecular weight heparin along with rehabilitation training.

Outcomes: At 8 days postadmission, his consciousness was improved and at the 6-month follow-up visit, his muscle power of bilateral upper and lower limbs was normal except still poor right handgrip power.

Lessons: Stroke or cerebral infarction should be considered and promptly managed in rare cases of M pneumoniae pneumonia with neurologic manifestations.

Figure 1

Chest computed tomography (CT) scan of a 7-year-old boy with Mycoplasma pneumoniae pneumonia complicated with cerebral infarction reveals solidification of the left lung with atelectasis of the left upper lobe and left pleural effusion.

Figure 2

Bronchoscopy reveals massive cordlike plugs in the bronchial cavity of the anterior segment of the left upper lobe (A), the lingua (B), and the posterior basal segment of the left lower lobe (C). (D) Cords removed during bronchoscopy showing a branching pattern. The longer cord is 2.5 cm with a diameter of 0.4 and the shorter one is 1.2 cm with a diameter of 0.2.

Figure 3

Pathologic examination of bronchoalveolar lavage fluid shows type 1 plastic bronchitis. Hematoxylin and eosin (H&E) staining. Magnification, 10× (A) and 40× (B).

Figure 4

MRA fails to visualize the left internal carotid artery, the MCA, and its distal branches, suggesting the presence of cerebral infarction (A). MRI DWI demonstrates hyperintensity in the left frontoinsular cortex, involving the internal capsule and basal ganglia (B). MCA = middle cerebral artery, MRA = magnetic resonance angiography.