Mycoplasma pneumoniae Pneumonia With Multiple Thromboses and Airway Stenosis:

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Case Report: Mycoplasma pneumoniae Pneumonia With Multiple Thromboses and Airway Stenosis

Abstract

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children and young adults. While typically self-limited, severe cases can present with extrapulmonary complications, including vascular thromboses and airway involvement. We report a pediatric case of severe M. pneumoniae pneumonia complicated by multiple thromboses and airway stenosis, highlighting the diagnostic challenges and management strategies.

Case Presentation

A previously healthy X-year-old child presented with a two-week history of fever, persistent cough, and respiratory distress. Initial examination revealed tachypnea, decreased breath sounds, and oxygen desaturation.

Investigations:

• Bloodwork: Elevated inflammatory markers (CRP, ESR, ferritin, and D-dimer).
• Chest X-ray: Patchy consolidation.
• High-resolution CT (HRCT) scan: Extensive lung consolidation with bronchial wall thickening and segmental collapse.
• PCR and Serology: Positive for Mycoplasma pneumoniae.
• Ultrasound and CT angiography: Evidence of pulmonary embolism and deep vein thromboses (DVTs).
• Bronchoscopy: Severe subglottic and tracheal narrowing, confirming airway stenosis.

Diagnosis

Severe Mycoplasma pneumoniae pneumonia with multifocal thromboses and airway stenosis.

Management & Treatment

1. Antimicrobial therapy:

   • Azithromycin (first-line macrolide).
   • Doxycycline or fluoroquinolone (if no response).

2. Anticoagulation:

   • Low-molecular-weight heparin (LMWH) for thrombosis management.

3. Corticosteroids:

   • High-dose methylprednisolone for airway inflammation.

4. Airway management:

   • Close monitoring in PICU.
   • Consideration for bronchodilators and potential tracheal intervention (stenting or balloon dilation) if progressive stenosis.

5. Supportive care:

   • Oxygen therapy, physiotherapy, and thrombophilia workup.

Outcome & Follow-up

• Gradual improvement with resolution of pneumonia and thrombi.
• Persistent airway narrowing required prolonged monitoring and possible intervention.

Discussion

• Hypercoagulability in Mycoplasma pneumoniae infections may result from immune-mediated endothelial injury and procoagulant effects.
• Airway involvement is a rare but serious complication requiring early bronchoscopy and corticosteroids.
• Clinicians should maintain a high index of suspicion for thrombosis in severe cases and initiate timely anticoagulation.

Conclusion

This case highlights the multisystem complications of Mycoplasma pneumoniae and underscores the importance of early recognition and aggressive management of thrombosis and airway compromise.

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