Cholestatic Hepatitis as a Main Manifestation of Mycoplasma pneumoniae Infection

Arav‐Boger, Ravit; Assia, Ayala; Spirer, Z; Bujanover, Yoram; Reif, Shimon

doi:10.1097/00005176-199511000-00015

Cited by 21 publications

(19 citation statements)

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“…The wide range of incidences of M. pneumoniae- related hepatitis reported may be due to the retrospective nature of these previous studies and/or the diverse definitions of hepatitis used in these different studies. The most well-recognized manifestation of M. pneumoniae -related hepatitis is elevation of ALT levels, while a few case reports of cholestatic hepatitis have been also documented [14,15,16]. In the current study, we observed that M. pneumoniae infection affected the hepatobiliary system of 21% of patients with M. pneumoniae infection.…”

Section: Discussionsupporting

confidence: 52%

Clinical Characteristics of Patients with Mycoplasma pneumoniae-Related Acute Hepatitis

Shin¹,

Park²,

Kim³

et al. 2012

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Background/Aims: Although the hepatobiliary manifestations of Mycoplasma pneumoniae infection have been described in several previous studies, controversies still remain. The aim of this study was to evaluate the clinical characteristics of patients with M. pneumoniae-related hepatitis and compare to those with M. pneumoniae infection but not hepatitis. Methods: We reviewed the medical chart of patients diagnosed with M. pneumoniae infection serologically. Results: Among the 117 patients with M. pneumoniae infection enrolled in the study, 25 showed acute hepatitis without any evidence of another cause. Patients with hepatitis presented with prodromal symptoms more frequently and also had a higher body temperature and C-reactive protein (CRP) levels than patients without hepatitis. Frequencies of respiratory tract involvement were not different between two groups. Clinical signs recovered within three weeks in both groups following the institution of antibiotic therapy. Multivariate analysis revealed that male sex, age <40 years, and high CRP levels were significantly linked to M. pneumoniae-related hepatitis. Conclusions: We found that acute hepatitis associated with M. pneumoniae occurred in about 21% of all M. pneumoniae infections, and gender, age, and CRP levels were factors related to the occurrence of M. pneumoniae-related hepatitis.

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Section: Discussionsupporting

confidence: 52%

Clinical Characteristics of Patients with Mycoplasma pneumoniae-Related Acute Hepatitis

Shin¹,

Park²,

Kim³

et al. 2012

Digestion

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“…These include nausea, vomiting, and diarrhea. Rarely, cholestatic hepatitis and pancreatitis have been associated with respiratory infections (11,174,381,386).…”

Section: Extrapulmonary Manifestationsmentioning

confidence: 99%

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

2004

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Mycoplasma pneumoniae is a unique bacterium that does not always receive the attention it merits considering the number of illnesses it causes and the degree of morbidity associated with it in both children and adults. Serious infections requiring hospitalization, while rare, occur in both adults and children and may involve multiple organ systems. The severity of disease appears to be related to the degree to which the host immune response reacts to the infection. Extrapulmonary complications involving all of the major organ systems can occur in association with M. pneumoniae infection as a result of direct invasion and/or autoimmune response. The extrapulmonary manifestations are sometimes of greater severity and clinical importance than the primary respiratory infection. Evidence for this organism's contributory role in chronic lung conditions such as asthma is accumulating. Effective management of M. pneumoniae infections can usually be achieved with macrolides, tetracyclines, or fluoroquinolones. As more is learned about the pathogenesis and immune response elicited by M. pneumoniae, improvement in methods for diagnosis and prevention of disease due to this organism may occur

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“…Symptoms range from mild fever and nonproductive cough to severe pneumonia. Extrapulmonary manifestations include the central nervous system as well as the cardiovascular, gastrointestinal, and hematological systems (1,2,5,6). This case demonstrates that hepatobiliary involvement of M. pneumoniae can occur in the immunocompetent adult.…”

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confidence: 99%

Acute Mycoplasma pneumoniae Infection Presenting as Cholestatic Hepatitis

Grüllich¹,

Baumert

Blum

2003

J Clin Microbiol

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A previously healthy 35-year-old man presented with fever, coughs, and jaundice. After flu-like symptoms for 2 weeks, the patient developed mild jaundice and high fever. On admission to our hospital, the physical examination revealed scleral jaundice and was otherwise unremarkable. Body temperature was 39.5°C. Chest X ray showed a patchy dense infiltration of the right lower lobe. Abdominal ultrasound showed small bilateral pleural effusions and minimal ascites. Abnormal laboratory findings on admission included alanine aminotransferase (ALT), 79 U/liter (normal, Ͻ23 U/liter); bilirubin, 2.8 mg/dl (normal, Ͻ1.2 mg/dl); alkaline phosphatase, 753 U/liter (normal, Ͻ200 U/liter); serum albumin, 2.7 g/dl (normal, Ͼ3.5 g/dl); and international normalized ratio, 2.1 (normal, 1.0).Known causes of acute hepatitis were excluded: anti-hepatitis A virus immunoglobulin M (IgM), negative; HBsAg and anti-HBc, negative; anti-HCV, negative; anti-nuclear antibodies, Ͻ1:10; antimitochondrial antibodies, negative; antismooth-muscle antibodies, negative; and no evidence for acute infection with herpes simplex virus, cytomegalovirus, or Epstein-Barr virus. Further, there was no evidence for hemochromatosis or WilsonЈs disease. Alcoholic or drug-induced hepatitis was excluded by the patientЈs history.Further serologic workup revealed acute infection with Mycoplasma pneumoniae (IgG enzyme immunoassay [EIA], 263 U/ml; IgA EIA, 162 U/ml; IgM EIA, 338 U/ml (titers of Ͼ64 U/ml are considered positive). Antibiotic therapy was started with cefuroxime given intravenously; 1 day later, therapy was changed to clarithromycin (500 mg orally twice daily for 3 weeks), resulting in a quick improvement of the patientЈs clinical condition. Ten days after the initiation of the antibiotic therapy, the pulmonary infiltration had disappeared. Liver function tests also improved quickly (Fig. 1), except for the ALT elevation, which persisted about 6 months before returning to normal levels.Infection with M. pneumoniae primarily affects the respiratory tract. Symptoms range from mild fever and nonproductive cough to severe pneumonia. Extrapulmonary manifestations include the central nervous system as well as the cardiovascular, gastrointestinal, and hematological systems (1,2,5,6). This case demonstrates that hepatobiliary involvement of M. pneumoniae can occur in the immunocompetent adult. Hepatobiliary involvement of M. pneumoniae infection was confirmed by the close temporal association of impaired liver function test results with clinical and radiological findings typical for M. pneumoniae infection and the exclusion of other causes of cholestatic hepatitis. To date, M. pneumoniae-associated cholestatic hepatitis has been reported only for children (1-3). The pathogenesis of extrapulmonary disease in M. pneumoniae infection is poorly understood. Possible mechanisms include infection of epithelial cells as well as an immune-mediated damage by cross-reactive anti-M. pneumoniae antibodies. A well-described feature of mycoplasma infection is the development ...

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Cholestatic Hepatitis as a Main Manifestation of Mycoplasma pneumoniae Infection

Cited by 21 publications

References 0 publications

Clinical Characteristics of Patients with Mycoplasma pneumoniae-Related Acute Hepatitis

Clinical Characteristics of Patients with Mycoplasma pneumoniae-Related Acute Hepatitis

Mycoplasma pneumoniaeand Its Role as a Human Pathogen

Acute Mycoplasma pneumoniae Infection Presenting as Cholestatic Hepatitis

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