Multiple anatomic sites of infarction in a pediatric patient with M. pneumoniae infection, a case report

Abstract

Background Although M. pneumoniae (M. pneumoniae) infections have been associated with various extrapulmonary manifestations, there have been very few documented cases of thrombotic events in pediatrics, and none to our knowledge with such extensive involvement as the patient described here. We aim to contribute to the urgency of discovering the mechanism of the coagulopathy associated with M. pneumoniae infections. Case presentation This 10-year-old boy was admitted after 2 weeks of fever, sore throat, worsening cough, and progressive neck and back pain. During hospitalization, he developed clots in several different organs: bilateral pulmonary emboli, cardiac vegetations, multiple splenic infarcts, and deep venous thromboses in three of four extremities. He was treated with long-term antibiotics and anticoagulation, and fully recovered. Conclusions This is the first case known to us of a child with an extensive number of thrombotic events in multiple anatomic sites associated with M. pneumoniae infection. The mechanism by which M. pneumoniae infection is related to thrombotic events is not fully understood, but there is evidence that the interplay between the coagulation pathways and the complement cascade may be significant. This patient underwent extensive investigation, and was found to have significant coagulopathy, but minimal complement abnormalities. By better understanding the mechanisms involved in complications of M. pneumoniae infection, the clinician can more effectively investigate the progression of this disease saving time, money, morbidity, and mortality.

A Case of Severe Psittacosis Pneumonia Complicated by Splenic Infarction

“…Recent years have seen an uptick in case reports of splenic infarction associated with infections, as documented in both domestic and international literature. Researchers such as Childer, Hahn, and Yin Wenwen [13][14][15] have reported rare instances of splenic infarction linked to infections like COVID-19, Mycoplasma pneumoniae, and Brucella. However, reports of splenic infarction due to Chlamydia psittaci infection are nonexistent.…”

“…Additionally, infections can lead to endothelial dysfunction of vascular cells, triggering brin formation and platelet adhesion and aggregation, ultimately causing splenic artery thrombosis [16]. Further, evidence indicates that the interplay between coagulation pathways and the complement cascade in Mycoplasma pneumoniae infections could lead to infarctions across various anatomical sites [14]. Given that Chlamydia and Mycoplasma are atypical pathogens, the similarity of their thrombotic mechanisms in infections warrants additional investigation.…”

Necrotizing Pneumonia in Children: Early Recognition and Management

“…Children with Mycoplasma pneumoniae pneumonia (MPP) infection are related to higher risks of blood coagulation and thrombosis. Several studies have shown that pulmonary embolism, stroke, splenic infarction, myocardial infarction and even extensive thrombotic events are associated with Mycoplasma pneumoniae infection in children [ 118 , 119 , 120 , 121 , 122 ]. Furthermore, a recent study demonstrates that elevated D-dimer, specifically >11.1 mg/L (even >5.0 mg/L), would assist in the early diagnosis of thrombosis in MPP [ 123 ].…”

Clinical, Hematological, Biochemical and Radiological Characteristics for Patients With Splenic Infarction: Case Series With Literature Review

“…Infection Cytomegalovirus [6][7][8] Epstein-Barr virus [9][10][11][12][13][14][15] Infective endocarditis [16][17][18][19][20][21][22] COVID-19 [23][24][25][26][27][28][29][30][31][32][33][34][35] Dengue virus [36] Mycoplasma pneumoniae [37,38] Malaria [39,40] Scrub typhus [41,42] Aspergillus pericarditis [43] Babesiosis [44] Malignancy including neoplasm and myeloproliferative diseases…”