A six year old girl, who was pre-morbidly well, presented to our emergency department on day 6 of illness. She presented with high grade intermittent fever for
6 days associated with periumbilical abdominal pain, non-bilious vomiting and loose stools for a day. There was history of mild cough since day 3 of illness.
There was no other associated systemic symptoms.
She was febrile and tachypneic at presentation, with signs of compensated shock. Her Q-SOFA score was three, indicating severe illness. She was resuscitated
with intravenous crystalloids, oxygen and inotropes. She was started on intravenous antibiotics after obtaining blood for aerobic culture. Her abdominal examination
revealed mild hepatomegaly and her other systemic examinations were normal. She was admitted in our Paediatric intensive care unit. Infectious causes like
Severe sepsis / Enteric fever / scrub typhus with features of compensated shock were differentials considered clinically.
Mycoplasma , the smallest free-living microorganisms are ubiquitous in nature. Of this group, seventeen have been identified as human pathogens.
Mycoplasma pneumoniae, Mycoplasma hominis, and Ureaplasma urealyticum found to cause disease frequently in children. M. pneumonia ferments carbohydrates
and requires sterol for growth. It grows under both anaerobic and aerobic conditions, but growth is more consistent when it is incubated in nitrogen and 5
percent carbon dioxide. When compared with other mycoplasmas isolated from humans, M. pneumoniae grows relatively slowly, with visible formation of colonies
rarely occurring in less than 1 week and possibly taking 3 weeks or more.
Mycoplasma can be detected easily by cold agglutinin method, detection of IgM / IgA antibodies by ELISA method and also polymerase chain reaction method.
Azithromycin and clarithromycin both are approved for the treatment of community-acquired pneumonia and severe disease in children.
In more serious illness such as Stevens-Johnson syndrome and neurologic disease, individual case studies have indicated little evidence of therapeutic
benefit with either erythromycin or tetracycline therapy. Corticosteroids have been used in severe conditions like steven Johnson, neurological manifestation,
severe pneumonia and hemolytic anemia.
Hence we report a case of Severe mycoplasma pneumoniae infection with atypical manifestations- severe pneumonia associated with hepatitis,
thrombocytopenia and coagulopathy, who recovered well with adequate intravenous azithromycin therapy. We conclude that Mycoplasma infection should be considered as
differential in atypical extrapulmonary clinical manifestations as listed above.