Diagnostic Challenges in Pulmonary Embolism in Young Adults: Thrombosis Associated With Cytomegalovirus and Mycoplasma pneumoniae

Abstract

A 23-year-old man presented with a fever, shaking chills, headaches, nausea, and a dry cough. Investigations showed lymphocytic leukocytosis with atypical lymphocytes in a blood smear. Liver function test results, D-dimer concentrations, and fibrin degradation product concentrations were greatly elevated. Computed tomography of the whole body with contrast showed hepatosplenomegaly with splenic infarction and bilateral pulmonary embolism without deep vein thrombosis. Cytomegalovirus (CMV) immunoglobulin M, and serum CMV pp65 antigenemia were positive, and serum Mycoplasma pneumoniae (M. pneumoniae) antibody was also highly positive. These results suggested the diagnosis of co-infection of CMV and M. pneumoniae complicated by systemic arteriovenous thrombosis, which resulted in pulmonary embolism and splenic infarction. After he started edoxaban tosilate hydrate for the thrombosis, his symptoms resolved in a few days. To the best of our knowledge, this is the first case of co-infection of CMV and M. pneumoniae leading to pulmonary embolism and splenic infarction.

Keywords: cytomegalovirus (cmv); lupus anticoagulant; mycoplasma pneumoniae infection; pulmonary embolism (pe); splenic infarction.

Figure 1. Initial imaging study of the chest

An enhanced CT image of the chest on initial presentation shows left pulmonary embolisms (framed areas).

Figure 2. Initial imaging study of the chest

An enhanced CT image of the chest on initial presentation shows right pulmonary embolisms (framed areas).

Figure 3. Initial imaging study of the abdomen

An initial enhanced CT image of the abdomen shows hepatosplenomegaly and a splenic infarction (arrow).