Severe mycoplasma pneumoniae pneumonia combined with cold agglutinin disease and pulmonary embolism in childhood: A case report and review of the literature

Liang S, Liu HB

Abstract

This was a case report and literature review, aimed to strengthen the understanding and therapy of mycoplasma pneumoniae (MP) pneumonia combined with cold agglutinin disease and pulmonary embolism in children. A 7-year-old boy was taken to the hospital with fever for 7 days, cough for 5 days, and recurrent cyanosis at the extremities of one day duration. Pulmonary artery computed tomography angiography (CTA) showed pulmonary embolism, double pneumonia, and pleural effusion. Mycoplasma (MP) antibody IgM, Coombs test, and anti C3d were positive while anti-IgG was negative. After treatment, the patient improved. One month after discharge, the Coombs test was negative, and pulmonary CTA showed no pulmonary embolism. The diagnosis was severe MP with cold agglutinin disease and pulmonary embolism. The cases were reviewed, involving a total of 18 cases. Two patients had pulmonary embolism, and one had Raynaud’s phenomenon with superior mesenteric artery and popliteal artery embolism. After treatment, 16 cases recovered while two cases were lost to follow up. We conclude that although the disease may be associated with severe complications such as embolism, acrocyanosis, and gangrene, the prognosis is relatively good for most patients.

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References

Kumar S. Mycoplasma pneumoniae: A significant but

underrated pathogen in paediatric community-acquired

lower respiratory tract infections. Indian J Med Res.

; 147(1):23-31.

Meyer Sauteur PM and Beeton ML. Mycoplasma

pneumoniae: gone forever? The Lancet Microbe. 2023;

(10):e763.

Waites KB, Xiao L, Liu Y, Balish MF and Atkinson TP.

Mycoplasma pneumoniae from the Respiratory Tract

and Beyond. Clin Microbiol Rev. 2017; 30(3):747-809.

Zhang X, Sun R, Hou J, Jia W, Li P, Song C and Cheng Y.

Clinical characteristics and risk factors of pulmonary

embolism with Mycoplasma pneumoniae pneumonia in

children. Sci Rep. 2024; 14(1):24043.

Moonla C, Watanaboonyongcharoen P, Suwanpimolkul G,

Paitoonpong L, Jantarabenjakul W,

Chanswangphuwana C, Polprasert C, Rojnuckarin P

and Putcharoen O. Cold agglutinin disease following

SARS-CoV-2 and Mycoplasma pneumoniae coinfections. Clin Case Rep. 2020; 8(12):2402-2405.

Pulmonary embolism. Nat Rev Dis Primers. 2018; 4:18031.

Machanahalli Balakrishna A, Reddi V, Belford PM, Alvarez

M, Jaber WA, Zhao DX and Vallabhajosyula S.

Intermediate-Risk Pulmonary Embolism: A Review of

Contemporary Diagnosis, Risk Stratification and

Management. Medicina (Kaunas). 2022; 58(9)

Ramiz S and Rajpurkar M. Pulmonary Embolism in

Children. Pediatr Clin North Am. 2018; 65(3):495-507.

Xu H, Li H, Xu Q, Zhang Z, Wang P, Li D and Guo L.

Automatic detection of pulmonary embolism in

computed tomography pulmonary angiography using

Scaled-YOLOv4. Medical physics. 2023; 50(7):4340-

Carroll BJ, Larnard EA, Pinto DS, Giri J and Secemsky EA.

Percutaneous Management of High-Risk Pulmonary

Embolism. Circulation Cardiovascular interventions.

; 16(2):e012166.

Berentsen S. How I treat cold agglutinin disease. Blood.

; 137(10):1295-1303.

Berentsen S, Malecka A, Randen U and Tjønnfjord GE.

Cold agglutinin disease: where do we stand, and where

are we going? Clinical advances in hematology &

oncology : H&O. 2020; 18(1):35-44.

Jäger U, Barcellini W, Broome CM, Gertz MA, Hill A, Hill

QA, Jilma B, Kuter DJ, Michel M, Montillo M, Röth

A, Zeerleder SS and Berentsen S. Diagnosis and

treatment of autoimmune hemolytic anemia in adults:

Recommendations from the First International

Consensus Meeting. Blood reviews. 2020; 41:100648.

Berentsen S. New Insights in the Pathogenesis and Therapy

of Cold Agglutinin-Mediated Autoimmune Hemolytic

Anemia. Front Immunol. 2020; 11:590.

Shankar EM, Vignesh R, Balakrishnan P, Velu V, Ponmalar

E, Murugavel KG, Saravanan S, Nandagopal P, Hayath

K, Solomon S, Vengatesan A and Rao UA. Cold

agglutinins in HIV-seropositive participants and

diagnosis of respiratory disease due to Mycoplasma

pneumoniae. Journal of the International Association of

Physicians in AIDS Care (Chicago, Ill : 2002). 2009;

(4):229-34.

Tang LH, et al. A case of Mycoplasma pneumoniae

pneumonia complicated with cold agglutinin disease

treated with integrated traditional Chinese and western

medicine. Journal of Changchun University of

Traditional Chinese Medicine. 2009; 25(3):413.

Zuo XQ. Mycoplasma pneumonia complicated with cold

agglutinin syndrome: a case report. Qinghai Medical

Journal. 2010; 40(12):65.

Tan XY, et al. Two cases of severe mycoplasma pneumonia

in adults with cold agglutinin-mediated anemia and

literature review. Chinese Journal for Clinicians. 2013;

(9):22-25.

Guo HY, et al. Acute pulmonary embolism caused by

Mycoplasma pneumoniae pneumonia and cold

agglutinin disease: a case report. Chinese Journal of

Respiratory and Critical Care. 2012; 11(3):305-306.

Basu S, Saifudeen A and Kaur P. Transient cold agglutinin

disease with mycoplasma infection. J Assoc Physicians

India. 2009; 57:656-7.

Khan FY and M Ay. Mycoplasma pneumoniae associated

with severe autoimmune hemolytic anemia: case report

and literature review. Braz J Infect Dis. 2009; 13(1):77-

Gursel O, Altun D, Atay AA, Bedir O and Kurekci AE.

Mycoplasma pneumoniae infection associated with

pancytopenia: a case report. J Pediatr Hematol Oncol.

; 31(10):760-2.

Wilson ML, Menjivar E, Kalapatapu V, Hand AP, Garber J

and Ruiz MA. Mycoplasma pneumoniae associated

with hemolytic anemia, cold agglutinins, and recurrent

arterial thrombosis. South Med J. 2007; 100(2):215-7.

Sudhakar M, Mohandoss V, Chaudhary H, Ahluwalia J,

Bhattarai D and Jindal AK. Multifocal thrombosis with

peripheral gangrene in a young boy: Mycoplasma

infection triggered cold agglutinin disease.

Immunobiology. 2021; 226(3):152075.

Shah M, Khan S and Chan K. Mycoplasma pneumonia with

persistent lymphadenopathy and severe cold agglutinin

haemolysis. Respir Med Case Rep. 2016; 19:196-198.

Atta M, Brannigan ET and Bain BJ. Cold autoimmune

hemolytic anemia secondary to atypical pneumonia.

Am J Hematol. 2017; 92(1):109.

Lindström FD and Ståhl-Furenhed B. Autoimmune

haemolytic anaemia complicating Mycoplasma

pneumoniae infection. Scand J Infect Dis. 1981;

(3):233-5.

Kumaravel Kanagavelu AS, Nagumantry SK, Sagi SV and

Oyibo SO. A Rare Case of Severe Hemolytic Anemia

and Pulmonary Embolism Secondary to Mycoplasma

pneumoniae Infection. J Med Cases. 2022; 13(3):119-

Maresh H, Klimek JJ and Quintiliani R. Myocardial

dysfunction and hemolytic anemia in a patient with

Mycoplasma pneumoniae infection. Chest. 1977;

(3):410-3.

Han X, et al. Adult Mycoplasma pneumonia complicated

with hemolytic anemia: a case report and literature

review. Chinese Journal of Tuberculosis and

Respiratory. 2011; 34(11):832-836.

Gu L, Chen X, Li H, Qu J, Miao M, Zhou F, Zhu Y, Wang

X, Wang C, Liu Y, Li W and Cao B. A case of lethal

hemolytic anemia associated with severe pneumonia

caused by Mycoplasma pneumoniae. Chin Med J

(Engl). 2014; 127(21):3839.

Daxböck F, Zedtwitz-Liebenstein K, Burgmann H and

Graninger W. Severe hemolytic anemia and excessive

leukocytosis masking mycoplasma pneumonia. Ann

Hematol. 2001; 80(3):180-2.

Respiratory group SoP, Chinese Medical Association.

Expert consensus on diagnosis and treatment of

Mycoplasma pneumoniae pneumonia in children (2015

edition). Chinese Clinical Journal of Practical

Pediatrics. 2015; 30(17):1304-1308.

Guideline for diagnosis and treatment of autoimmune

hemolytic anemia in children (2021).

Swiecicki PL, Hegerova LT and Gendrtz MA. Cold

agglutinin disease. Blood. 2013; 122(7):1114-21.

Mosdósi B, Nyul Z, Nagy A, Bölcskei K, Decsi T and

Helyes Z. Severe acrocyanosis precipitated by cold

agglutinin secondary to infection with Mycoplasma

pneumoniae in a pediatric patient. Croat Med J. 2017;

(6):424-430.

Berentsen S. How I manage patients with cold agglutinin

disease. Br J Haematol. 2018; 181(3):320-330.

Zhang JB, et al. A case of routine blood condensation caused

by mycoplasma pneumonia. Chinese Medical Journal.

; 14(1)

Huang Z, et al. Int J Clin Exp Med. Mycoplasma

pneumoniae pneumonia complicated with pulmonary

embolism. 2016; 9(6):11574-11581.

Broome CM, Cunningham JM, Mullins M, Jiang X, Bylsma

LC, Fryzek JP and Rosenthal A. Increased risk of

thrombotic events in cold agglutinin disease: A 10-year

retrospective analysis. Res Pract Thromb Haemost.

; 4(4):628-635

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