A Challenging Presentation of Mycoplasma pneumoniae: Mild Hepatic Dysfunction With Persistent Leukocytosis in a...

Area of Science:

• Pediatrics
• Infectious Diseases
• Hepatology

Background:

• Mycoplasma pneumoniae (MP) is a common pediatric respiratory pathogen.
• MP can rarely cause extrapulmonary manifestations, including hepatic involvement.
• Recognizing hepatic dysfunction in MP infections is crucial for diagnosis and treatment.

Purpose of the Study:

• To highlight a rare case of Mycoplasma pneumoniae presenting with hepatic dysfunction in a pediatric patient.
• To emphasize the importance of considering atypical MP presentations for timely diagnosis and management.
• To illustrate the diagnostic challenges and successful treatment of MP-associated hepatitis.

Main Methods:

• Case report of a five-year-old female with asthma presenting with symptoms suggestive of hepatic involvement.
• Laboratory evaluation including complete blood count, liver function tests, coagulation profile, and MP serology.
• Clinical observation during empiric antibiotic treatment and subsequent targeted therapy.

Main Results:

• The patient presented with fever, cough, jaundice, elevated liver enzymes, direct hyperbilirubinemia, coagulopathy, and anemia.
• Initial workup for infectious and hepatic causes was inconclusive.
• Initiation of azithromycin following positive MP IgM serology correlated with the normalization of hepatic indices and hematologic parameters.

Conclusions:

• Mycoplasma pneumoniae can present with rare extrapulmonary manifestations, including mild hepatic dysfunction and transient hematologic changes.
• Atypical presentations of MP necessitate a high index of suspicion for accurate diagnosis.
• Timely diagnosis and appropriate antibiotic therapy (azithromycin) can effectively manage MP-associated hepatic dysfunction, preventing prolonged hospitalization.