Mycoplasma pneumoniae associated with severe autoimmune hemolytic anemia: case report and literature review

Abstract

We report a case of severe hemolytic anemia following Mycoplasma pneumoniae infection in a 29-year-old male patient who was treated with azithromycin. Direct Coombs' test was strongly positive and the cold agglutinin titer was high, with anti-I specificity. Antimycoplasma antibody titer by complement fixation was high 1:10,240. The patient was discharged after 12 days of hospitalization in good health. He remains clinically well with no recurrence of jaundice.

AN UNUSUAL CASE OF MYCOPLASMA PNEUMONIAE‐ASSOCIATED AUTOIMMUNE HAEMOLYTIC ANAEMIA IN A 10‐YEAR‐OLD FEMALE CHILD

“…1 In men with low bone mineral density (BMD), 1 year of treatment with oral once-monthly 150-mg ibandronate significantly increased BMD at both the lumbar spine and hip, reduced bone turnover and was generally well tolerated. 2 Once-monthly oral administration of bisphosphonate may be more convenient for patients and improves therapeutic adherence, thereby optimising outcomes.…”

“…2 Once-monthly oral administration of bisphosphonate may be more convenient for patients and improves therapeutic adherence, thereby optimising outcomes. 1,2 In children with low BMD and a history of fractures, bisphosphonates are being administered with increasing frequency as off-label drugs. Bisphosphonates, although not licensed for use in children, are nevertheless used in paediatrics on the basis of accepted practice.…”

“…Haemolytic anaemia secondary to M. pneumoniae-associated cold antibodies is described in adults with a more aggressive treatment approach. 1 On the contrary, anaemia in the majority of children in previous studies is usually self-limited and children recover with supportive care. [2][3][4] The description of this new paediatric case not only emphasises the difficulty of differential diagnosing a child having the aforementioned clinical picture but also the need to conduct larger epidemiological studies concerning the incidence, severity and outcome of extrapulmonary manifestations induced by M. pneumoniae since this clinical entity might be more common than a paediatrician believes.…”

Autoimmune Hemolytic Anemia Confers an Independent Risk Factor for Thrombosis: Retrospective Cohort Study Using the “STRIDE” Database

“…50-60% of AIHA cases are believed to be secondary [3][4][5]. Major risk factors for secondary AIHA include malignancy [6], viral and mycoplasma infections [7,8], and rheumatologic disorders [9]. AIHA treatment remains largely based on expert opinion without a clear consensus due to limited prospective data [10,11].…”

Cold Agglutinin Disease

“…Anti-IgG antibodies mediate the latter group against P-antigen that can cause primary or secondary paroxysmal cold hemoglobinuria; secondary is usually associated with syphilis or children with acute viral syndrome. 6 Cold agglutinin syndromes mediated by IgM autoantibodies can cause primary or idiopathic CAD, which is typically associated with clonal B-lymphocyte proliferation, 7,8 and also can be seen post-infectious 9,10,11,12 or associated with malignant B-cell neoplasm. 8 Thermal amplitude, defined as the highest temperature at which antigen-antibody interaction occurs, is regarded as more clinically significant than cold agglutinin titer.…”