An Unusual Complication of Mycoplasma Infection

We present the case of an 8 year old boy with an unusual complication of mycoplasma pneumonia. He presented to his local hospital with cough, coryza and fever for 9 days. He developed significant respiratory distress and commenced intravenous antibiotics, but required escalation of respiratory support to optiflow, CPAP, then required intubation and ventilation and further escalation to high frequency oscillation.

Initial chest x-ray showed dense consolidation of the right lung, which progressed to a right sided white out.

He was treated with intravenous antibiotics with atypical cover. Pleural tap was negative for bacterial growth and nasopharyngeal aspirate for extended respiratory viruses was negative, but serology was positive for mycoplasma pnuemoniae.

He developed a swollen right leg; Doppler ultrasound showed thrombus from the right external iliac to the popliteal vein. He commenced anti-coagulation and his case was discussed with a quarternary centre. He had a CTPA performed showing extensive bilateral pulmonary emboli, consolidation and infarction with hepatomegaly.

After 3 weeks he was extubated to CPAP and remained tachypnoeic but not hypoxic. An IVC filter and clot extraction were discussed because of sub-therapeutic Anti Xa levels, however it was felt the risks outweighed the benefits. He remained on bed rest until his factor Xa level was therapeutic due to risk of further emboli. Repeat CTPA was performed in view of persistent temperatures and to reassess the clot burden and right lung. This showed consolidation and cavitating infarctions with an enlarging effusion.

Conservative management with intravenous antibiotics was continued; two weeks later oral antibiotics and warfarin were introduced. His pulmonary pressures normalised on echocardiogram and he continued to make good progress.

There are cases of pulmonary infarction secondary to mycoplasma infection in the literature. We present a complicated course and interesting images requiring multi-disciplinary and multi-site discussions eventually achieving excellent outcomes.