A Rare Case of Extra-Pulmonary Manifestation of Mycoplasma pneumoniae

Abstract

Background and aim: Mycoplasma pneumoniae is one of the many organisms causing pneumonia in children. It commonly presents with pulmonary manifestations however uncommonly infection with M. pneumoniae causes extra-pulmonary manifestations. Involvement of liver is one of such rare extra-pulmonary manifestations of M. Pneumoniae. Direct and indirect hits along with vascular occlusion leading to liver injury have been postulated to be the cause of liver involvement. Case presentation: A 10-year-old African American boy with mild obstructive sleep apnea, chronic migraine, gastroesophageal reflux presented with 5-day history of rash, fever, emesis, dark urine, diarrhea, thrush, decreased oral intake and abdominal pain. The rash didn't improve with diphenhydramine at home. Patient was initially tachycardic, tachypneic, and febrile to 39.6°C. Initial physical examination revealed, scleral icterus, maculopapular erythematous diffuse rash all over the body, bilateral conjunctivitis, with right upper quadrant tenderness but no organomegaly. Initial laboratory results showed moderate transaminitis, along with elevated bilirubin, however initial imaging study was found to be normal. The patient over the course of his admission continued to spike high fevers and WBC counts continued to rise. Conclusion: Mycoplasma pneumoniae is often thought to cause pulmonary disease and very few cases have been presented with extra-pulmonary manifestations. Early diagnosis and initiation appropriate therapy improves outcome and decreases the incidence of extra-pulmonary manifestations.