Mycoplasma pneumoniae infection associated with urticarial vasculitis mimicking adult-onset Still’s disease

Abstract

Mycoplasma pneumoniae is well known to be a frequent cause of atypical pneumonia worldwide. However, it may also present with a wide variety of clinical features, including cutaneous symptoms, which are not widely recognised. Urticarial vasculitis occurring with M. pneumoniae has been described to occur in only one other case report. This amalgamation of non-specific clinical symptoms and signs can lead to a diagnostic dilemma. We describe a case of M. pneumoniae infection presenting with extrapulmonary manifestations and urticarial vasculitis, which was misdiagnosed as adult-onset Still's disease (AOSD). Had immunosuppressive therapy been commenced for AOSD in the presence of undiagnosed infection, this may have resulted in potentially serious consequences. This case highlights the need to remain vigilant about diagnosing M. pneumoniae as its serological diagnosis may take weeks and it has many extrapulmonary manifestations, which can masquerade as other conditions.

A Persistently Febrile Adolescent with Headache and Vision Changes

“…The organism is very difficult to grow in culture conditions, 2 and often the diagnosis is made over several weeks by noting a fourfold increase in serological testing between paired acute and convalescent samples. [2][3][4]7 Clinicians must have a high suspicion in children with neurological symptoms who do not have clear diagnoses.…”

“…[1][2][3] Additionally, transverse myelitis, GuillainBarre syndrome, seizures, cerebellar ataxia, psychosis, and aseptic meningitis can also occur. [1][2][3][4][5][6][7][8] Interestingly, both neurological and vascular symptoms seem to occur in patients who do not have the typical respiratory manifestations of Mp, [1][2][3]5,6 and so clinicians must have a high index of suspicion for Mp in patients who may have atypical clinical features.…”

“…usually presents with a cough as well as constitutional symptoms including fever and malaise, 2,4 although Mp is also known to cause a wide array of extra-pulmonary symptoms involving almost every organ system, including the central nervous system (CNS). [1][2][3][4][5][6][7][8] These extra-pulmonary symptoms may resemble other disease processes, so the diagnosis may be delayed or missed. 1,[3][4][5] The diagnosis of extrapulmonary Mp disease is difficult for several reasons, even when the clinician considers it in the differential.…”

“…[1][2][3][4][5][6][7][8] These extra-pulmonary symptoms may resemble other disease processes, so the diagnosis may be delayed or missed. 1,[3][4][5] The diagnosis of extrapulmonary Mp disease is difficult for several reasons, even when the clinician considers it in the differential. The organism is very difficult to grow in culture conditions, 2 and often the diagnosis is made over several weeks by noting a fourfold increase in serological testing between paired acute and convalescent samples.…”

“…Mp typically causes upper and lower respiratory infections, [1][2][3][4][5][6] and is transmitted by aerosols. usually presents with a cough as well as constitutional symptoms including fever and malaise, 2,4 although Mp is also known to cause a wide array of extra-pulmonary symptoms involving almost every organ system, including the central nervous system (CNS).…”