Infect Chemother.  2009 Jun;41(3):190-195. 10.3947/ic.2009.41.3.190.

Corticosteroid Treatment in Siblings Affected with Severe Mycoplasma pneumoniae Pneumonia

• Kim DH
• Lee KY
• Kim MS
• Youn YS
• Hwang JY
• Rhim JW
• Kang JH
• Lee JS

• KMID: 1782323
• DOI: http://doi.org/10.3947/ic.2009.41.3.190

Abstract

Numerous evidences support the pathogenesis that M. pneumoniae pneumonia is associated with cell-mediated immune reaction. We report 2 cases of severe M. pneumoniae pneumonia in previously healthy sisters, who were both admitted during an epidemic of M.pneumoniae pneumonia. The elder sister, who was 16 years old, was admitted with M. pneumoniae pneumonia. She showed no response to treatment with clarithromycin and levofloxacin, and eventually progressed to severe ARDS, requiring mechanical ventilation. After treatment with hydrocortisone (200 mg/day), there were rapid improvements in clinical manifestations and chest radiographic findings. The younger sister, who was 14 years old, was admitted 10 days later, presenting with fever but no pneumonic lesions on chest radiograph. Just like her sister, the infection showed no response to clarithromycin. Fever persisted and pneumonic consolidation with mild pleural effusion was noticed in the left lower lobe on the 5th hospital-day. After treatment with oral prednisolone (1 mg/kg), she showed rapid defervescence and on the 8th hospital day, no pneumonic lesions were detectable on chest radiograph. Given the fact that the pathogenesis of pneumonia and extrapulmonary manifestations in M. pneumoniae infection is immune-mediated, an immunosuppressive therapy would be validated for selected patients with M. pneumoniae infections.

Keyword

Mycoplasma pneumoniae; Pneumonia; Corticosteroids

MeSH Terms

Adrenal Cortex Hormones
Clarithromycin
Fever
Humans
Hydrocortisone
Mycoplasma
Mycoplasma pneumoniae
Ofloxacin
Pleural Effusion
Pneumonia
Pneumonia, Mycoplasma
Prednisolone
Respiration, Artificial
Siblings
Thorax
Adrenal Cortex Hormones
Clarithromycin
Hydrocortisone
Ofloxacin
Prednisolone

Figure

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  Figure 1 Chest X-ray findings of case-1. A) Initial chest radiograph shows multifocal pneumonic consolidations in both lung fields with left pleural effusion. B) Further progression of extensive pneumonic consolidations and pleural effusion in both lung fields are present on the 3rd hospital day. C) Chest X-ray shows markedly improved lung lesions after corticosteroid therapy on the 8th hospital day.

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  Figure 2 Chest X-ray findings of case-2. A) Initial chest radiograph shows no definitive pneumonic consolidation in both lung fields except suspicious increased density on left retrocadiac region. B) Fine reticular pneumonic consolidation in left lower lobe with mild blunting of costopleural angle is shown on the 4th hospital day. C) There is resolution of pneumonic consolidation after corticosteroid therapy on the 7th hospital day.

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