Pediatr Gastroenterol Hepatol Nutr.  2015 Sep;18(3):209-215. 10.5223/pghn.2015.18.3.209.

Acute Necrotizing Pancreatitis Associated with Mycoplasma pneumoniae Infection in a Child

• Yang A
• Kang B
• Choi SY
• Cho JB
• Kim YJ
• Jeon TY
• Choe YH

• KMID: 2068800
• DOI: http://doi.org/10.5223/pghn.2015.18.3.209

Abstract

Mycoplasma pneumoniae is responsible for approximately 20% to 30% of community-acquired pneumonia, and is well known for its diverse extrapulmonary manifestations. However, acute necrotizing pancreatits is an extremely rare extrapulmonary manifestation of M. pneumoniae infection. A 6-year-old girl was admitted due to abdominal pain, vomiting, fever, and confused mentality. Acute necrotizing pancreatitis was diagnosed according to symptoms, laboratory test results, and abdominal computed tomography scans. M. pneumoniae infection was diagnosed by a 4-fold increase in antibodies to M. pneumoniae between acute and convalescent sera by particle agglutination antibody assay. No other etiologic factors or pathogens were detected. Despite the occurrence of a large infected pseudocyst during the course, the patient was able to discharge without morbidity by early aggressive supportive care. This is the first case in Korea of a child with acute necrotizing pancreatitis associated with M. pneumoniae infection.

Keyword

Mycoplasma pneumoniae; Pancreatitis; Acute necrotizing

MeSH Terms

Abdominal Pain
Agglutination
Antibodies
Child*
Female
Fever
Humans
Korea
Mycoplasma pneumoniae*
Mycoplasma*
Pancreatitis
Pancreatitis, Acute Necrotizing*
Pneumonia
Pneumonia, Mycoplasma*
Vomiting
Antibodies

Figure

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  Fig. 1 (A) Initial contrast-enhanced computed tomography (CT) scans of the abdomen shows diffuse enlargement of the pancreas body and tail. Poor pancreatic parenchymal enhancement is also shown, suggesting necrosis of the pancreas and peripancreatic fluid collection with ascites. A non-occlusive thrombus in the superior mesenteric vein is also noted (white arrow). (B) Initial abdomen ultrasonography shows diffuse pancreatic swelling and low echogenicity of the total pancreas body, which correlates with the results of the abdominal CT scan.

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  Fig. 2 (A) Follow up computed tomography (CT) scans of the abdomen conducted on the seventh hospital day shows enlarged low attenuated area with thin enhancing wall, suggestive of a pseudocyst. (B) Abdomen sonography demonstrates a 10×4.8 cm sized pseudocyst containing debris, which are consistent with the findings of the follow up CT scans.

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  Fig. 3 Serum Mycoplasma pneumoniae (MP) antibody (Ab) titers of the patient. HD: hospital day, IgG: immunoglobulin G.

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  Fig. 4 (A) Computed tomography scans of the abdomen, which were conducted 4 months after discharge show normal enhancement of the remaining pancreas without pancreatic duct dilatation (small arrows). No abnormal peripancreatic fluid collection and pseudocyst was observed. The thrombus initially observed in the superior mesenteric vein (SMV) is not demonstrated (large arrow). (B) Abdominal ultrasonography, which was conducted 6 months after discharge show normal parenchymal echogenicity of the remnant pancreas without ascites or SMV thrombus.

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