Chest Infections: Fellow Case Report Poster - Chest Infections II |

Mycoplasma Pneumoniae Infection Associated With Massive Pulmonary Embolism FREE TO VIEW

Yue Lu, MD; Luis Moreta-Sainz, MD
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Cedars-Sinai Medical Center, Los Angeles, CA

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):124A. doi:10.1016/j.chest.2016.08.133
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SESSION TITLE: Fellow Case Report Poster - Chest Infections II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION:Mycoplasma pneumoniae infections are often self-limited in young adults. The need for hospitalization and the mortality rate is low. But M. pneumoniae can result in severe complications, such as hemolytic anemia and thromboembolism.

CASE PRESENTATION: 65 year old female with no significant pmhx and on no medications presenting with shortness of breath, fevers, nausea and vomiting, cough with yellowish sputum to the emergency department for three weeks. She was hypoxemic, tachypneic, had respiratory and metabolic acidosis. On peripheral blood smear she had severe hemolytic anemia with Hb=2 and was positive for cold agglutin. Chest x-ray was clear and CT scan of thorax showed mild bilateral opacities at the bases. She had leukocytosis, anuric renal failure. On admission to ICU, she had septic shock and was started on vasopressors and CRRT. A new RBBB developed (Image 1). Her chest xray remained unchanged (Image 2), rheumatological and infectious serologies were sent but she continued to more hypotensive and went into PEA arrest on hospital day 2. She was unable to be resuscitated. Her autopsy showed massive saddle PE.

DISCUSSION: PE is rare cause of death in mycoplasma infection. It is unsure if thromboembolism was secondary to M. pneumoniae infection or due to venous status in very ill patients. Cold agglutin induced hemolysis was thought to cause a hypercoagulable state resulting in widespread thromboembolism. A case series recommends that prophylaxis against and investigation for thromboembolism should be considered in life- threatening cases (1). In children where M. pneumoniae is a more common cause of pneumonia, during the thrombotic event, anticardiolipin IgG and IgM and antiphospholipid Ag were positive (which resolve after the resolution of PE). Therefore, infection was thought to cause the development of autoantibodies which were associated with PE (2). Cases of PE diagnosed before death were treated successfully with anticoagulation.

CONCLUSIONS: If a patient with M. pneumoniae infection and severe cold agglutin hemolytic anemia has worsening oxygenation or hypotension and worsening hemodynamic instability, thromboembolism shoud be considered. Atypical pneumonia antibiotic coverage can prevent sequelae of severe infection.

Reference #1: Chan, E et al. Fulminant Mycoplasma pneumonia Pneumonia. West J Med 1995;162:133-142.

Reference #2: Brown, SM, et al. Mycoplasma pneumonia and pulmonary embolism in a child due to acquired prothrombotic factors. Pediatric Pulmonology (2008);43:200-202.

DISCLOSURE: The following authors have nothing to disclose: Yue Lu, Luis Moreta-Sainz

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