Mycoplasma Pneumoniae Pneumonia Complicated With Embolism:5 Cases And Literature Review

Objective:To improve our understanding of the clinical manifestation,diagnosis and the treatment of mycoplasma pneumoniae pneumonia(MPP)-related embolism.Methods:5 cases of MPP complicated with embolism,who were hospitalized in Children’s Hospital of Zhejiang University,and 33 cases reported from January 1990 to January 2017 are retrospectively analyzed.Results:The age range of these 5 cases was from 4 years and 10 months to 10 years.4 cases were boys.3 children had liver function damage,3 had increased D-dimer and fibrinogen.3 cases had bilateral lung lesion,3 accompanied with pleural effusion and 1 with pericardial effusion.All of 5 cases were made a definite diagnosis by imaging examinations,of them 2 cases with cerebral infarction,2 pulmonary embolisms and 1 splenic infarction.All these 5 children were treated with anticoagulants,one used urokinase for thrombolysis,among whom 4 children were partially recovered at discharge.33 cases were searched from Medline,of them 20 were boys and the ages ranged from 3 to 13 years old.Most embolic complications happened at the second to the twenty-third day from onset of the disease.Middle cerebral arterial occlusion was the most common location in single embolism,followed by deep vein thrombosis(DVT)of lower limbs,and DVT often occurred with pulmonary embolism.8 of these 33 cases had transient positive results of the anticardiolipin antibody,20 with elevated D-dimer and 12 with increased fibrinogen.After surgery,thrombolysis or using anticoagulants,most children had a good outcome except 2 died and 1 lost his sight.Conclusion:Clinicians should evaluate the thrombotic risks in the patients with mycoplasma pneumoniae infection.For those suspicious patients,imaging examinations should be immediately performed,and once diagnosed with certainty,patients need to be treated with thrombolysis and/or anticoagulants to improve the prognosis as soon as possible.