Publication:

Refractory Mycoplasma pneumoniae with cytokine storm: a case report with an atypical presentation

Mycoplasma pneumoniae is a significant cause of community-acquired pneumonia in children. Macrolide-resistant M. pneumoniae (MRMP) has been observed worldwide, with varying incidence rates. MRMP infections have a poor response to macrolide antibiotics, which further results in prolonged fever, extended antibiotic treatment, increased hospitalization, critical care unit admissions, and a significantly higher proportion of patients needing to receive glucocorticoids or second-line antibiotics. A 5-year-old girl presented with high-grade fever and lobar consolidation due to M. pneumoniae. She didn’t respond to macrolides. She developed features of cytokine storm with elevated ferritin, transaminitis etc. She was started on levofloxacin, given intravenous immunoglobulin and systemic corticosteroids, following which defervescence occurred. Early and rapid identification of resistant Mycoplasma infection is important. Appropriate antibiotic treatment, along with immunosuppressive therapy, is warranted for children with refractory M. pneumoniae pneumonia (MRMP).