Severe pediatric Mycoplasma pneumonia as the cause of diffuse alveolar hemorrhage requiring veno-venous extracorporeal membrane oxygenation: A case report

Abstract

Background: Diffuse alveolar hemorrhage (DAH) is an acute life-threatening disease often associated with immunocompromised patients and systemic disorders, such as infections, vasculitis, and toxins. Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia in children, which rarely causes respiratory failure and fulminant disease; However, a rapid progression may occur in some patients. Mycoplasma pneumonia-associated DAH is rare.

Case presentation: We report a case of severe pediatric mycoplasma pneumonia in an immuno-competent child. This patient's condition progressed rapidly, with severe lung lesions associated with pleural effusion, coagulopathy, diffuse alveolar haemorrhage and severe respiratory distress requiring ventilator and intravenous extracorporeal membrane oxygenation (VV-ECMO) support. She was discharged upon successful treatment.

Conclusion: Diffuse alveolar hemorrhage associated with Mycoplasma pneumoniae in children is very rare, and clinicians should be aware of the potential rapid onset of the disease. Early detection and diagnosis are very important. The main treatment measures include anti-infection and supportive measures such as mechanical ventilation, but as in our case, success with both prone positioning for more than 10 h per day and VV-ECMO was life-saving.

Keywords: acute respiratory distress syndrome; diffuse alveolar hemorrhage; mNGS; mycoplasma pneumoniae; pediatric; veno-venous extracorporeal membrane oxygenation.

Figure 1

Initial chest radiograph on hospitalization day 1 showing diffuse opacification on the left lung, atelectasis in the right lung, and a large effusion in the right pleural cavity.

Figure 2

(A) Chest computed tomography scan on hospitalization day 1 showing double lung infection and right lung consolidation density; multiple lymph nodes in mediastinum the mediastinum show that the area is slightly larger; bilateral pleural effusion. (B) After 8 days of therapy, a computed tomography scan of the chest shows exudate changes in both lungs, partial consolidation in the right lung, similar lesions as initially observed, interstitial changes in the right lower lung with multiple bronchial cystic changes, and reactive lymphadenopathy. (C) Forty-five days after hospital discharge, the pulmonary lesions on computed tomography were significantly absorbed compared to earlier.