Allergy Asthma Respir Dis.  2017 May;5(3):169-174. 10.4168/aard.2017.5.3.169.

Two patients with Mycoplasma pneumoniae pneumonia progressing to acute respiratory distress syndrome

• Kwon JE
• Ahn JY
• Choi BS

• KMID: 2379946
• DOI: http://doi.org/10.4168/aard.2017.5.3.169

Abstract

Mycoplasma pneumoniae pneumonia is one of the most prevalent community-acquired pneumonias in pediatric patients. It commonly presents with mild respiratory symptoms and is well controlled by macrolide antibiotics. Rarely, it can progress to acute respiratory distress syndrome (ARDS) despite appropriate antibiotic therapy, and systemic corticosteroids and quinolone antibiotics are required. We recently treated 2 patients who presented with M. pneumoniae pneumonia with ARDS. Case 1: A 17-year-old girl was admitted with pneumonia that showed no response to antibiotics and progressed to ARDS, which required initiation of mechanical ventilation therapy. The patient was negative for M. pneumoniae IgM; but positive for, M. pneumoniae. After treatment with methylprednisolone and levofloxacin, rapid improvement was observed in both clinical manifestations and chest radiographic findings. Two days after discontinuing a 5-day methylprednisolone treatment regimen, she developed fever, and investigations revealed an elevated C-reactive protein level; this necessitated additional methylprednisolone treatment. Subsequently, she showed complete recovery with no sequelae. Case 2: A 14-year-old girl was admitted with M. pneumoniae pneumonia with ARDS that required mechanical ventilation therapy. She showed a IgM titers against M. pneumoniae of 1:320. After treatment with antibiotics and methylprednisolone, she recovered and was discharged at 48 admission days; however, mild dyspnea persisted. The chest computed tomography showed multiple bronchiectasis areas. After 15 days, because of aggravated dyspnea, she was readmitted and adminis-tered methylprednisolone pulse therapy. Despite 3 courses of methylprednisolone pulse therapy, she still showed mild dyspnea.

Keyword

Mycoplasma; Acute respiratory distress syndrome; Child; Methylprednisolone; Macrolide resistant

MeSH Terms

Adolescent
Adrenal Cortex Hormones
Anti-Bacterial Agents
Bronchiectasis
C-Reactive Protein
Child
Dyspnea
Female
Fever
Humans
Immunoglobulin M
Levofloxacin
Methylprednisolone
Mycoplasma pneumoniae*
Mycoplasma*
Pneumonia*
Pneumonia, Mycoplasma*
Radiography, Thoracic
Respiration, Artificial
Respiratory Distress Syndrome, Adult*
Thorax
Adrenal Cortex Hormones
Anti-Bacterial Agents
C-Reactive Protein
Immunoglobulin M
Methylprednisolone

Figure

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  Fig. 1. Chest X-ray findings of case 1. (A) Initial chest radiograph shows pneumonic infiltration in right lower lung field with pleural effusion. (B) On the 5th hospital day, follow-up chest X-ray shows more aggravated pneumonic consolidations and pleural effusion in both lung fields. (C) There are further progression of extensive pneumonic consolidation in both lung field and increasing pleural effusion on the 12th hospital day.

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  Fig. 2. (A, B) Chest computed tomography (CT) scan findings of case 1. (A) Chest CT, on the 5th hospital day, shows pneumonic consolidations in both lung and bilateral moderate amount of pleural effusion. (B) After 1 month of treatment, follow-up chest CT shows much improvement of pneumonic infiltration, but still peribronchial infiltrations with multifocal fibrotic changes in both lung fields.

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  Fig. 3. Hospital course of case 1.

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  Fig. 4. Chest X-ray findings of case 2. (A) Initial chest radiograph shows diffuse pneumonic consolidation in right middle lung filed and diffuse patchy consolidation in both lung fields. (B) Follow-up chest X-ray shows much improved after 19 days of treatment.

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  Fig. 5. Hospital course of case 2 at 1st admission.

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  Fig. 6. Chest radiograph findings of case 2 at 2nd admission. (A) Chest X-ray shows slight aggravation of pneumonic infiltration on both lung fields. (B) There are new pneumonic infiltrations in left lung filed. Bronchiectasis is shown in both lung fields.

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  Fig. 7. (A, B) Chest computed tomography scan on the 15th hospital day shows slight improvement of pneumonic infiltration in the left lung fields, but aggravated bronchiectasis.

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  Fig. 8. Hospital course of case 2 at 2nd admission.

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