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Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection

Yu Hyeon Choi1, Hyung Joo Jeong1, Bongjin Lee1

  • 1Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.

Korean Journal of Critical Care Medicine
|November 15, 2019
PubMed

Insights

Pediatric acute cerebral infarction is rare but can follow Mycoplasma pneumoniae infection. This case highlights a severe stroke linked to macrolide-resistant MP, requiring aggressive treatment including a craniectomy.

Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Diseases

Background:

  • Acute cerebral infarction is an uncommon but serious complication in children.
  • Mycoplasma pneumoniae (MP) infection can lead to neurological complications through various mechanisms including vasculitis and hypercoagulable states.

Observation:

  • A 5-year-old boy presented with extensive stroke across multiple cerebrovascular territories 10 days post-MP infection diagnosis.
  • The MP infection was suspected to be macrolide-resistant, prompting specific treatment protocols.

Findings:

  • Cerebral infarction in this case was attributed to a combination of hypercoagulability and cytokine-induced vascular inflammation.
  • Despite treatment with levofloxacin, methyl-prednisolone, IVIG, and enoxaparin, the patient experienced progressive cerebral vascular narrowing.

Implications:

  • This case underscores the potential for severe neurological sequelae from Mycoplasma pneumoniae infections in children.
  • Aggressive and multi-modal treatment, including consideration for surgical intervention like decompressive craniectomy, may be necessary for survival in complex pediatric stroke cases.
  • Further research into the mechanisms of MP-associated pediatric stroke and optimal therapeutic strategies is warranted.
Keywords:
cerebral infarctionchildmycoplasma pneumoniaethrombosisvasculitis

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