Pediatr Infect Vaccine.  2019 Apr;26(1):71-79. 10.14776/piv.2019.26.e9.

A Child of Severe Mycoplasma pneumoniae pneumonia with Multiple Organ Failure Treated with ECMO and CRRT

• Hwang W
• Lee Y
• Lee E
• Lee JM
• Kil HR
• Yu JH
• Chung EH

• KMID: 2443168
• DOI: http://doi.org/10.14776/piv.2019.26.e9

Abstract

Mycoplasma pneumoniae (MP) is the most common causative agent of community-acquired pneumonia in school-aged children. An 8-year-old boy who had been diagnosed with autism looked severely ill when he presented to our hospital due to dyspnea and lethargy. He had fever and cough 7 days prior to hospitalization. He had signs and symptoms of severe respiratory distress. The percutaneous oxygen saturation was 88% at high oxygen supply. Chest radiography showed diffusely increased opacity with moderate pleural effusion. He was intubated immediately and admitted to the intensive care unit. Under the clinical impression of mycoplasmal pneumonia, intravenous clarithromycin was started. Laboratory findings showed leukocytosis, hepatitis, decreased renal function, and presence of serum MP immunoglobulin (Ig) M (+) IgG (+) and sputum MP polymerase chain reaction (+). On hospital day 2, the patient developed multiple organ failure with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (ECMO) was performed with continuous renal replacement therapy (CRRT) and was weaned successfully. This is the first reported case of an ARDS due to MP infection complicated by multiple organ failure that was successfully treated with ECMO and CRRT in South Korea.

Keyword

Mycoplasma pneumoniae; Pneumonia; Acute respiratory distress syndrome; Extracorporeal membrane oxygenation; Renal replacement therapy

MeSH Terms

Autistic Disorder
Child*
Clarithromycin
Cough
Dyspnea
Extracorporeal Membrane Oxygenation*
Fever
Hepatitis
Hospitalization
Humans
Immunoglobulin G
Immunoglobulins
Intensive Care Units
Korea
Lethargy
Leukocytosis
Male
Multiple Organ Failure*
Mycoplasma pneumoniae*
Mycoplasma*
Oxygen
Pleural Effusion
Pneumonia*
Pneumonia, Mycoplasma*
Polymerase Chain Reaction
Radiography
Renal Replacement Therapy
Respiratory Distress Syndrome, Adult
Sputum
Thorax
Clarithromycin
Immunoglobulin G
Immunoglobulins
Oxygen

Figure

• 

  Fig. 1 Chest radiographic changes (A) Diffuse increased opacity in both lower lobe, pleural effusion both at admission (HD#1). (B) Diffuse increased opacity, right lung, consolidation in left upper lobe and left lower lung zone after ECMO catheter removal (HD#18). (C) Atelectasis in the central portion of left upper lobe before discharge (HD#105). (D) Diffuse bronchial wall thickening in both lungs, and suspicious peribronchial infiltration in right lower lobe (326 days after discharge). Abbreviation: HD, hospital day; ECMO, extracorporeal membrane oxygenation.

• 

  Fig. 2 Progression of the patient's condition and treatment. Abbreviation: Ig, immunoglobulin; ECMO, extracorporeal membrane oxygenation; CRRT, continuous renal replacement therapy; HD, hospital day.

• 

  Fig. 3 Chest computed tomographic changes (A) Atelectasis in the posterior segment of both upper lobe; superior, posterior, and lateral basal segments of right lower lobe and right middle lobe; lingular division of left upper lobe; and superior and anteromedial basal segment of left lower lobe. Multifocal intrathoracic loculated air (HD#37). (B) Diffuse mosaic attenuation in both lungs, diffuse bronchial wall thickening in right upper lobe and both lower lobe (HD#111). (C) Multifocal subsegmental/linear atelectasis in both lungs, diffuse bronchial wall thickening in left lower lobe (326 days after discharge). Abbreviation: HD, hospital day.

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