Rhabdomyolysis: An Unusual Presentation of Mycoplasma pneumoniae Infection in an Adult—A Case Report and Literature Review

Abstract

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia, and many extrapulmonary manifestations have been described, but rhabdomyolysis is infrequently reported in adults. Of the few cases that have been reported in adults, it was almost exclusively seen when pneumonia was present. We report a case of a 30-year-old male who came in with complaints of fever and myalgia for three days. Immunoglobulin M antibodies for Mycoplasma pneumoniae were positive and trending up, despite having no radiographic evidence of pneumonia on chest X-ray or CT scan. He was treated successfully with levofloxacin and intravenous hydration. Later, his condition was clinically and biochemically improved, and he was discharged. Our patient did not present with typical respiratory tract symptoms of a mycoplasma infection. In addition, there was an absence of pneumonia on imaging, suggesting that rhabdomyolysis secondary to mycoplasma might be underdiagnosed and go untreated in the setting of low clinical suspicion. Upon review of the literature, there is only one other case of mycoplasma infection where rhabdomyolysis occurred in the absence of pneumonia. However, the degree of rhabdomyolysis in our case was much more severe. Although rare, when faced with rhabdomyolysis, Mycoplasma pneumoniae should be kept as a differential diagnosis even in the absence of pneumonia on radiological imaging.

Rhabdomyolysis with Acute Kidney Injury Caused by Bilateral Iliopsoas Hematoma in a Patient with Atrial Fibrillation

“…Several causes of rhabdomyolysis are reported, being mainly divided into traumatic and non-traumatic causes (6). Crush syndrome is a well-known traumatic cause, but there are a variety of non-traumatic causes as well, such as a hereditary predisposition, infection, electrolyte imbalance, and side effects of medication (6,7). Trauma with muscle damage is often reported as a cause of rhabdomyolysis, and iliopsoas hematoma is a relatively rarely seen cause.…”

Rhabdomyolysis: A Case Report of an Extrapulmonary Presentation of Mycoplasma pneumoniae

“…Rhabdomyolysis is a rare extrapulmonary manifestation of M. pneumoniae, and literature review reveals it to be infrequently described in healthy adults. [3][4][5][6][7] The rod-shaped bacterium is excreted from the respiratory tract weeks after the acute infection and has been associated with acute hepatitis, immune thrombocytopenic purpura, Stevens- Johnson syndrome, and transverse myelitis. 1,2 The pathogenicity of M. pneumoniae has been linked to the activation of inflammatory mediators such as cytokines.…”

“…The extrapulmonary presentation of rhabdomyolysis secondary to Mycoplasma pneumoniae is rare; to our knowledge there are only five previously documented cases in healthy adults. [3][4][5][6][7] As emergency physicians, we must maintain a wide differential and high suspicion to avoid missing potentially important secondary diagnoses critical to favorable patient outcome.…”

“…1,2 In rare circumstances patients develop extrapulmonary disease including dermatological, gastrointestinal, neurological, and musculoskeletal manifestations. [1][2][3] Rhabdomyolysis is one of these rare manifestations; a literature review reveals that most cases affect the pediatric population and a handful of cases reported in healthy adults. [3][4][5][6][7][8][9][10][11][12] We present an unusual case of St. Lucie Medical Center, Palm Beach Consortium for Graduate Medical Education, Department of Emergency Medicine, Port St. Lucie, Florida rhabdomyolysis secondary to M. pneumoniae in a healthy young adult female with hypoxia and myalgia.…”

Clinical implications of the genus Mycoplasma

“…Se han documentado manifestaciones digestivas como hepatitis, pancreatitis [ 172 , 173 , 174 ] y gastroenteropatía pierde proteínas [ 175 ]. A nivel musculoesquelético, se ha aislado en artrosis [ 176 ], miositis [ 177 ] y rabdomiólisis [ 178 ]. En el aparato urogenital, se ha implicado en nefritis intersticial [ 179 ], nefropatía IgA [ 180 ], glomerulonefritis y síndrome nefrótico [ 181 , 182 ] y priapismo [ 183 ].…”