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Cardiac thrombus and stroke in a child with Mycoplasma pneumoniae pneumonia: A case report
Yefeng Wang1, Yunbin Xiao1, Xicheng Deng2
1Department of Cardiology, Hunan Children's Hospital.
Rationale:
Cardiac thrombus and stroke are rare complications in Mycoplasma pneumoniae infection, which is a common cause of community-acquired pneumonia in children. Early detection and prevention of thrombus in children with M pneumoniae pneumonia is relatively difficult.
Patient Concerns:
A 5-year-old boy with severe M pneumoniae pneumonia was referred to our center. During the treatment with sufficient antibiotics, an echocardiography surprisingly revealed a thrombus in the left atrium, with significant changes in D-dimer level and anti-phospholipid antibodies. At day 12 after admission, the patient showed impaired consciousness, aphasia, and reduced limb muscle power. Magnetic resonance angiography (MRA) showed right middle cerebral artery infarction.
Diagnoses:
Cardiac thrombus and stroke associated with M pneumoniae pneumonia.
Interventions:
He was started on aggressive antibiotic therapy and urokinase thrombolytic therapy for 24 hours, continued with low molecular heparin calcium and aspirin along with rehabilitation training.
Outcomes:
On follow up, the D-dimer decreased slowly and echocardiograms showed a steadily decreasing size of thrombus with eventual disappearance at day 22 after admission. His left limb muscle power was improved after rehabilitation for 2 months.
Lessons:
Early diagnosis and treatment with multiple modalities maybe useful for improving prognosis of cardiac thrombus and stroke in M pneumoniae pneumonia. Changes in D-dimer level and anti-phospholipid antibodies should be routinely monitored in severe M pneumoniae pneumonia.
Insights
Early detection of cardiac thrombus and stroke in children with Mycoplasma pneumoniae pneumonia is crucial. Aggressive treatment, including antibiotics and thrombolytics, improved outcomes in a pediatric case.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Neurology
Background:
- Mycoplasma pneumoniae pneumonia is common in children.
- Cardiac thrombus and stroke are rare but serious complications.
- Early detection of these complications is challenging.
Observation:
- A 5-year-old boy with severe M. pneumoniae pneumonia developed left atrial thrombus and right middle cerebral artery infarction.
- Elevated D-dimer and positive anti-phospholipid antibodies were noted.
- Neurological deficits including impaired consciousness and aphasia were observed.
Findings:
- Aggressive antibiotic and urokinase thrombolytic therapy, followed by low molecular heparin and aspirin, led to thrombus resolution.
- D-dimer levels decreased, and echocardiograms showed a shrinking thrombus, disappearing by day 22.
- The patient showed improved limb muscle power after 2 months of rehabilitation.
Implications:
- Early diagnosis and multimodal treatment are vital for improving prognosis in M. pneumoniae-associated cardiac thrombus and stroke.
- Routine monitoring of D-dimer and anti-phospholipid antibodies is recommended for severe cases.
- This case highlights the importance of vigilance for thromboembolic events in pediatric M. pneumoniae infections.
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