ChronicMycoplasma pneumoniaeinfection in a child after renal transplantation

Abstract

Mycoplasma pneumoniae has rarely been reported in renal transplant recipients. We present the case of a 10-yr-old boy with a six-month history of chronic cough, recurrent pyrexia, and weight loss three yr after RTx. The patient's post-transplant course was complicated by recurrence of NS that resolved with plasmapheresis and PTLD, which was successfully treated with an anti-CD20 monoclonal antibody. Chest X-ray showed a round mass-like lesion in the left upper lobe; MRT, PET, and bronchoscopy ruled out a PTLD. BAL fluid revealed M. pneumoniae-DNA. A three-wk course of macrolide therapy induced rapid recovery. We conclude that M. pneumoniae infection should be considered in immunosuppressed patients with long-lasting respiratory complaints and fever of unknown origin. Antibiotic treatment should be given for a minimum of three wk.

Stevens–Johnson syndrome after Mycoplasma pneumonia infection in pediatric post‐liver transplant recipient: Case report and review of the literature

“…Schwerk et al. (9) described Mycoplasma‐induced SJS in a 10‐yr‐old male status post‐renal transplant, but there are no reports of Mycoplasma‐induced SJS in pediatric post‐liver transplant recipient.…”

“…Our patient was taking a sulfa‐containing antibiotic and her Mycoplasma IgM was positive, making it difficult to delineate a clear cause for the SJS. We used serology to diagnose the Mycoplasma infection, as described in other case reports of pediatric post‐transplant recipients with Mycoplasma‐associated SJS (10), but some authors suggest that PCR should be used to detect the presence of Mycoplasma (9, 11). Beersma et al.…”

“…(12) tested twelve different commercially available methods of detecting Mycoplasma IgM and IgG using PCR as the gold standard; finding higher sensitivity for detecting IgM (75–80%) in younger patients with at least a week of symptoms, but lower specificities and a wide range of sensitivity and specificity depending on the type of test, leading to the conclusion that PCR remains the method for identifying Mycoplasma. Some suggest repeat testing for IgM as it may be negative at early stages of the disease (9). Unfortunately, Mycoplasma PCR was not performed in our patient.…”

“…Early recognition and treatment of SJS is essential in post‐transplant recipients to decrease morbidity and mortality. Most cases in the pediatric literature report treatment with corticosteroids, IVIG, or a combination of both (4, 9, 14), and studies have shown conflicting results for the risks and benefits of these medications (5, 15). Some studies suggest that corticosteroids do not result in significant improvement of symptoms and increase susceptibility to infection, leading to poorer outcomes (1, 2, 13).…”

“…Some studies suggest that corticosteroids do not result in significant improvement of symptoms and increase susceptibility to infection, leading to poorer outcomes (1, 2, 13). IVIG improved outcomes in SJS in multiple studies but there is no accepted protocol outlining dose and length of treatment (9, 16). Our patient was already taking daily prednisone at the time of presentation, and no additional steroids were administered.…”