폐색전증과 비장경색이 동반된 마이코플라스마 폐렴 1예
A case of pulmonary thromboembolism and splenic infarction in mycoplasma pneumonia
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Mycoplasma pneumoniae pneumonia is one of the most common causes of community-acquired pneumonia in school-aged pediatric patients. Its severity varies ranging from mild respiratory symptoms to severe complications with atypical pneumonia. It can rarely produce nonpulmonary manifestations including thrombosis. We report a case of a 10-year-old girl with M. pneumoniae pneumonia accompanied by pulmonary embolism and splenic infarction. She was readmitted with fever and left lower chest pain when coughing and left upper abdominal pain. Chest radiography showed abnormalities in the lower lobe of the left lung and pleural effusion. Blood tests revealed an elevated C-reactive protein level. Chest computed tomography (CT) showed left pleural effusion, thromboembolism of the descending branch of the right pulmonary arterial as well as infarction at the upper portion of the spleen. Laboratory evaluations revealed positivity to antimycoplasma antibodies; IgM, sputum mycoplasma polymerase chain reaction, anticardiolipin IgM (18MPL: normal<11), and IgG (32GPL: normal<23). She was treated with intravenous clarithromycin and low-molecular heparin (LMWH, 1 mg/kg/day). Chest CT was performed on the 6th day of hospitalization, which showed improvement in thrombosis. We administered warfarin instead of LMWH to achieve an international normalized ratio 2.0–3.0. On the 11th day of hospitalization, the patient was uneventfully discharged. Following her discharge, we continued to administer warfarin to the patient. Three months later, we noticed that pulmonary embolism and splenic infarction had disappeared.
Abstract
Mycoplasma pneumoniae pneumonia is one of the most common causes of community-acquired pneumonia in school-aged pediatric patients. Its severity varies ranging from mild respiratory symptoms to severe complications with atypical pneumonia. It can rarely produce nonpulmonary manifestations including thrombosis. We report a case of a 10-year-old girl with M. pneumoniae pneumonia accompanied by pulmonary embolism and splenic infarction. She was readmitted with fever and left lower chest pain when coughing and left upper abdominal pain. Chest radiography showed abnormalities in the lower lobe of the left lung and pleural effusion. Blood tests revealed an elevated C-reactive protein level. Chest computed tomography (CT) showed left pleural effusion, thromboembolism of the descending branch of the right pulmonary arterial as well as infarction at the upper portion of the spleen. Laboratory evaluations revealed positivity to antimycoplasma antibodies; IgM, sputum mycoplasma polymerase chain reaction, anticardiolipin IgM (18MPL: normal<11), and IgG (32GPL: normal<23). She was treated with intravenous clarithromycin and low-molecular heparin (LMWH, 1 mg/kg/day). Chest CT was performed on the 6th day of hospitalization, which showed improvement in thrombosis. We administered warfarin instead of LMWH to achieve an international normalized ratio 2.0–3.0. On the 11th day of hospitalization, the patient was uneventfully discharged. Following her discharge, we continued to administer warfarin to the patient. Three months later, we noticed that pulmonary embolism and splenic infarction had disappeared.
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