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Case Reports
. 2017 May;32(2):211-217.
doi: 10.4266/kjccm.2016.00283. Epub 2016 Dec 29.

Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection

Yu Hyeon Choi  1 , Hyung Joo Jeong  1 , Bongjin Lee  1 , Hong Yul An  1 , Eui Jun Lee  1 , June Dong Park  1
Affiliations
Case Reports

Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection

Yu Hyeon Choi et al. Korean J Crit Care Med. 2017 May.

Abstract

Acute cerebral infarctions are rare in children, however they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokine-induced vascular inflammation.

Keywords: cerebral infarction; child; mycoplasma pneumoniae; thrombosis; vasculitis.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Chest radiogram on the day of admission shows consolidation and atelectasis in the right upper and left lower lung.
Figure 2.
Figure 2.
Magnetic resonance imaging (MRI) performed at the previous hospital on the day of admission. Axial section of diffusion-weighted MRI showing an area of restricted diffusion in the left thalamus (A), pons, and bilateral cerebellum (arrow) (B). Axial section of the apparent diffusion map showing a corresponding low apparent diffusion coefficient value in the left thalamus (arrow) (C), pons, and bilateral cerebellum (arrow) (D).
Figure 3.
Figure 3.
Magnetic resonance angiography (MRA) performed at the previous hospital on the day of admission. MRA image showing a filling defect (A) in the right vertebral artery (arrow) and (B) basilar artery (arrow) suggestive of thrombosis.
Figure 4.
Figure 4.
Magnetic resonance angiography image showing multifocal narrowing in both the middle cerebral artery and internal carotid artery (arrow) suggestive of vasculitis.
See this image and copyright information in PMC

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