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Central and Peripheral Nervous System Demyelination Following Mycoplasma Pneumonia Infection With Review of Literature FREE TO VIEW

Brian Miller, DO; Dr. Andres Zirlinger, MD
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Lehigh Valley Hospital, Fogelsville, PA

Chest. 2014;146(4_MeetingAbstracts):291A. doi:10.1378/chest.1990271
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SESSION TITLE: Critical Care Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Mycoplasma pneumoniae (M. pneumoniae) is a common culprit in both upper and lower respiratory tract infections. However, this bacterial pathogen has also been associated with an array of extrapulmonary manifestations. Neurologic complications appear to be the most common and severe nonpulmonary consequences of M. pneumoniae infection. Among these neurologic disorders, the combination of peripheral and central nervous system demyelination remains an extremely rare occurrence without a clear explanation of the involved pathogenesis.

CASE PRESENTATION: We report a unique case of an 18-year-old male who experienced respiratory tract symptoms with ascending limb weakness and pain. His clinical picture, neurophysiological test, and imaging were consistent with both central and peripheral nervous system demyelination. Serology confirmed the presence of an acute M. pneumoniae infection. His neurologic improvement occurred after intubation, plasmapheresis, intravenous dexamethasone, and macrolide therapy.

DISCUSSION: M. pneumoniae is associated with a wide spectrum of neurologic complications. These clinical manifestations range in severity and have been documented primarily through case reports within the medical literature. Central and peripheral nervous system involvement occur in approximately 0.01-4.8% of patients infected with M. pneumoniae [1]. However, the overall incidence of neurologic complications may be lower than expected, given that only a minority of M. pneumoniae patients have a confirmed infection and are hospitalized.

CONCLUSIONS: M. pneumoniae remains a common respiratory pathogen that is capable of causing a wide-spectrum of extrapulmonary complications. Neurologic disease occurs more frequently with severe complications in comparison to other nonpulmonary manifestations of M. pneumoniae. Timely diagnosis and treatment is hindered by the lack of a clearly defined pathogenesis, sensitivity and specificity of available diagnostic techniques, and clinical trials to assess therapeutic treatment options. After a careful review of the literature, the evidence supports an underlying autoimmune process responsible for our patient's central and peripheral nervous system demyelination following serological confirmation of a M. pneumoniae infection. Neurologic and clinical improvement of our patient's polyradiculopathy and transverse myelitis occurred after five treatments of plasmapheresis, seven days of intravenous dexamethasone, and ten days of azithromycin. Recognition of central and peripheral nervous system demyelination in association with respiratory tract symptoms should prompt serological and PCR investigation for M.pneumoniae.

Reference #1: Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review. Clin Infect Dis 1993;17 (Suppl 1) S52-S57.

Reference #2: Sanchez-Vargas F, M. pneumoniae - an emerging extra-pulmonary pathogen.Clin Microbiol Infect 2008;14:105-115.

DISCLOSURE: The following authors have nothing to disclose: Brian Miller, Dr. Andres Zirlinger

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