A rare case of diffuse alveolar hemorrhage caused by acute mycoplasma pneumoniae pneumonia

Abstract

Mycoplasma pneumoniae is a common bacterial pathogen that causes atypical communityacquired pneumonia. Illness onset can be gradual and progressive over weeks. Patients typically have cough, pharyngitis, malaise, and tracheobronchitis. Although symptoms are frequently mild, the initial presentation can be severe with numerous complications. We present a case of a 28-year-old male who presented with 1 day of significant hemoptysis. He was intubated for airway protection and underwent bronchoscopy, which showed multiple blood clots in several lung lobes, consistent with diffuse alveolar hemorrhage (DAH). His workup was negative for pulmonary embolism, coagulopathy, and vasculitis. He tested positive for rhinovirus and mycoplasma pneumoniae IgM (negative IgG). He was ultimately discharged home with oral doxycycline to complete a 10-day course. DAH is a rare presentation and life-threatening complication of mycoplasma pneumonia. Although there is a reported association between DAH and rhinovirus, our patient improved with antibiotics making mycoplasma pneumoniae the likely culprit. When encountering hemoptysis or alveolar bleeding, clinicians should have low suspicion for atypical infections and start appropriate antibiotics early in the clinical course.

Mycoplasma pneumoniae-associated diffuse alveolar haemorrhage: an atypical presentation of a prevalent pathogen

“…Because respiratory symptoms were prominent, bronchoscopy was performed early. In fact, extrapulmonary manifestations were present in only one of the reports 14–19. Our case is unique in that we describe a patient with MP-associated DAH who presented without respiratory symptoms.…”

“…It has been theorised that liver dysfunction is not from direct invasion of the bacterium into hepatocytes, but rather liver tissue producing an immunological response to the infection, such as what occurs in immunocompetent patients with infections from Ebstein-Barr virus 9 21. Although MP can cause haemolytic anaemia associated with cold agglutinins, our patient’s haemoglobin dropped from 140.2 g/L to a nadir of 70.6 g/L without evidence of haemolysis 18. His reticulocyte production index was 0.63, suggesting bone marrow suppression from severe illness contributing to his anaemia.…”

Severe pediatric Mycoplasma pneumonia as the cause of diffuse alveolar hemorrhage requiring veno-venous extracorporeal membrane oxygenation: A case report

“…To our knowledge, DAH associated with MP is very rare; there are only five other published cases in adults, and there have been no reports in children (7)(8)(9)(10)(11). DAH is a lifethreatening medical emergency with nonspecific symptoms and can result in respiratory failure and death.…”