Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection

Abstract

Acute cerebral infarctions are rare in children, however they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient’s survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokine-induced vascular inflammation.

Stroke associated with Mycoplasma hominis infection: a case report

“…The progression of cerebral infarction to the right cerebellar hemisphere despite antiplatelet treatment and close monitoring observed in our patient has also been described in a case report of a 5-year-old boy with MP infection [ 4 ]. The patient’s behavioral changes were attributed to the thalamic infarcts, as previously described [ 7 , 8 ].…”

“…Mycoplasma hominis has not been reported to be associated with stroke in the existing literature. However, multiple literature descriptions exist of strokes post- Mycoplasma pneumoniae (MP) infection, particularly in the pediatric population [ 4 – 6 ]. Because both bacteria belong to the same family, they might share a similar pathogenic correlation with stroke.…”

Thrombosis associated with mycoplasma pneumoniae infection (Review)

“…Arterial thrombosis is usually associated with plaque rupture, which triggers platelets to develop platelet rich clots; however, venous thromboembolism is associated with endothelial dysfunction and blood stasis, leading to fibrin-and erythrocyte-rich thrombus (62). Following Mycoplasma pneumoniae infection, thrombosis may occur in a different part of the body, sometimes affecting the prognosis of the disease (29,30). The present review summarizes the pathogenesis, clinical features, treatment and prognosis of thrombosis induced by Mycoplasma pneumoniae infection in order to better understand this complication.…”

“…Cerebral infarction developed 2 days to 3 weeks after Mycoplasma pneumoniae infection (29)(30)(31)(33)(34)(35)(36)(37)(38)(39)(40)(41)43,44). Chest imaging of certain patients revealed pulmonary embolism 11-29 days after Mycoplasma pneumonia infection (52).…”

“…The increased fibrinogen and D-dimer levels may induce a hypercoagulable state, which appears 6-15 days after Mycoplasma pneumoniae pneumonia onset (32). Extensive coagulation studies were performed, including plasma levels of clotting factors, proteins C and S, plasminogen, antithrombin III, lupus anticoagulant, sickle cell anemia, homocysteine antiphospholipid syndrome, disorders of fibrinolysis, anticardiolipin antibody and cold agglutinins (30,39,43,48). Tests for inherited thrombophilia are controversial and certain studies have suggested that these tests for inherited thrombophilia should never be performed (64).…”