Mycoplasma Pneumonia Causing Acute Hypoxemic Respiratory Failure

Abstract

INTRODUCTION: Mycoplasma pneumonia is a common cause of pneumonia. Most patients run a benign course, however, rarely patients can present with severe acute respiratory failure. CASE PRESENTATION: A 43-year-old male with history of tobacco use presented with 2-week history of progressive shortness of breath, fever, congestion, sore throat and productive cough. He progressed to severe hypoxemic respiratory failure requiring intubation. CT scan of the chest displayed diffuse nodular infiltrates in a miliary pattern (Figure 1). He underwent bronchoscopy with bronchoalveolar lavage. Cultures for bacteria, fungi and acid-fast bacilli were negative. He was initially started on broadspectrum antibiotics but had progressively worsening hypoxemic respiratory failure requiring transfer to our tertiary care facility. On arrival, he was started on airway pressure release ventilation and levofloxacin. Serology was positive for cold agglutinins and was notable for IgM to Mycoplasma pneumonia at 7847 U/mL (positive is >770). He was successfully extubated on hospital day 3 and was transitioned to azithromycin to complete a 2-week course of antibiotics. Three weeks after discharge from the hospital repeat CT of the chest revealed resolution of the nodular miliary pattern (Figure 2). DISCUSSION: Mycoplasma pneumonia is a common cause of pneumonia. It usually resolves spontaneously or with antibiotics. 50 to 75% of patients develop cold agglutinins. The gold standard for diagnosis of M. pneumoniae respiratory infection is a fourfold increase in antibody titer. PCR techniques for diagnosis are also being used more frequently. Macrolides are considered the treatment of choice, though fluoroquinolones and tetracyclines are also effective. M. pneumonia infection rarely has major complications, but infection complicated by ARDS has rarely been reported in the literature. CONCLUSIONS: Mycoplasma pneumonia is a common cause of pneumonia. Most cases in immunocompetent hosts run a benign course and resolve with antibiotics. However, it has rarely been described as causing acute respiratory failure and should be suspected in patients presenting with ARDS.