Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Complete occlusion of the right middle cerebral artery associated with Mycoplasma pneumoniae pneumonia

  • Kang, Ben (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Dong Hyun (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine) ;
  • Hong, Young Jin (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine) ;
  • Son, Byong Kwan (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine) ;
  • Lim, Myung Kwan (Department of Radiology, Inha University Hospital, Inha University School of Medicine) ;
  • Choe, Yon Ho (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwon, Young Se (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine)
  • Received : 2013.08.07
  • Accepted : 2014.07.19
  • Published : 2016.03.15
Download PDF
⟨ Previous Next ⟩

Abstract

We report a case of a 5-year-old girl who developed left hemiparesis and left facial palsy, 6 days after the initiation of fever and respiratory symptoms due to pneumonia. Chest radiography, conducted upon admission, showed pneumonic infiltration and pleural effusion in the left lung field. Brain magnetic resonance imaging showed acute ischemic infarction in the right middle cerebral artery territory. Brain magnetic resonance angiography and transfemoral cerebral angiography revealed complete occlusion of the right middle cerebral artery. Mycoplasma pneumoniae infection was identified by a 4-fold increase in IgG antibodies to M. pneumoniae between acute and convalescent sera by enzyme-linked immunosorbent assay. Fibrinogen and D-dimer levels were elevated, while laboratory exams in order to identify other predisposing factors of pediatric stroke were all negative. This is the first reported pediatric case in English literature of a M. pneumoniae-associated cerebral infarction involving complete occlusion of the right middle cerebral artery.

Keywords

References

  1. Tsiodras S, Kelesidis I, Kelesidis T, Stamboulis E, Giamarellou H. Central nervous system manifestations of Mycoplasma pneumoniae infections. J Infect 2005;51:343-54. https://doi.org/10.1016/j.jinf.2005.07.005
  2. Daxboeck F. Mycoplasma pneumoniae central nervous system infections. Curr Opin Neurol 2006;19:374-8. https://doi.org/10.1097/01.wco.0000236617.04958.60
  3. Visudhiphan P, Chiemchanya S, Sirinavin S. Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection. Pediatr Neurol 1992;8:237-9. https://doi.org/10.1016/0887-8994(92)90078-D
  4. Fu M, Wong KS, Lam WW, Wong GW. Middle cerebral artery occlusion after recent Mycoplasma pneumoniae infection. J Neurol Sci 1998;157:113-5. https://doi.org/10.1016/S0022-510X(98)00074-4
  5. Antachopoulos C, Liakopoulou T, Palamidou F, Papathanassiou D, Youroukos S. Posterior cerebral artery occlusion associated with Mycoplasma pneumoniae infection. J Child Neurol 2002;17:55-7. https://doi.org/10.1177/088307380201700115
  6. Tanir G, Aydemir C, Yilmaz D, Tuygun N. Internal carotid artery occlusion associated with Mycoplasma pneumoniae infection in a child. Turk J Pediatr 2006;48:166-71.
  7. Lee CY, Huang YY, Huang FL, Liu FC, Chen PY. Mycoplasma pneumoniae- associated cerebral infarction in a child. J Trop Pediatr 2009;55:272-5. https://doi.org/10.1093/tropej/fmn115
  8. Ryu JS, Kim HJ, Sung IY, Ko TS. Posterior cerebral artery occlusion after Mycoplasma pneumoniae infection associated with genetic defect of MTHFR C677T. J Child Neurol 2009;24:891-4. https://doi.org/10.1177/0883073808331081
  9. Narita M. Pathogenesis of neurologic manifestations of Mycoplasma pneumoniae infection. Pediatr Neurol 2009;41:159-66. https://doi.org/10.1016/j.pediatrneurol.2009.04.012
  10. Bitnun A, Richardson SE. Mycoplasma pneumoniae: innocent bystander or a true cause of central nervous system disease? Curr Infect Dis Rep 2010;12:282-90. https://doi.org/10.1007/s11908-010-0105-4
  11. Atkinson TP, Balish MF, Waites KB. Epidemiology, clinical manifestations, pathogenesis and laboratory detection of Mycoplasma pneumoniae infections. FEMS Microbiol Rev 2008;32:956-73. https://doi.org/10.1111/j.1574-6976.2008.00129.x
  12. Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010;16:162-9. https://doi.org/10.1007/s10156-010-0044-X
  13. Jordan LC, Hillis AE. Challenges in the diagnosis and treatment of pediatric stroke. Nat Rev Neurol 2011;7:199-208. https://doi.org/10.1038/nrneurol.2011.23
  14. Leonardi S, Pavone P, Rotolo N, La Rosa M. Stroke in two children with Mycoplasma pneumoniae infection. A causal or casual relationship? Pediatr Infect Dis J 2005;24:843-5. https://doi.org/10.1097/01.inf.0000177284.88356.56
  15. Monagle P, Chalmers E, Chan A, DeVeber G, Kirkham F, Massicotte P, et al. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008;133(6 Suppl):887S-968S. https://doi.org/10.1378/chest.08-0762

Cited by

  1. Low Diagnostic Yield of Routine Cerebrospinal Fluid Analysis in Juvenile Stroke vol.9, pp.None, 2016, https://doi.org/10.3389/fneur.2018.00694
  2. Stroke Associated With Recent Mycoplasma Pneumoniae Infection: A Systematic Review of Clinical Features and Presumed Pathophysiological Mechanisms vol.9, pp.None, 2016, https://doi.org/10.3389/fneur.2018.01109
  3. Refractory Mycoplasma pneumoniae pneumonia with concomitant acute cerebral infarction in a child : A case report and literature review vol.97, pp.13, 2016, https://doi.org/10.1097/md.0000000000010103
  4. Thrombotic Complications of Nose and Toe Associated With Mycoplasma pneumoniae Infection vol.10, pp.10, 2019, https://doi.org/10.14740/jmc3349
  5. Effects of Bronchoalveolar Lavage with Ambroxol Hydrochloride on Treating Pulmonary Infection in Patients with Cerebral Infarction and on Serum Proinflammatory Cytokines, MDA and SOD vol.2020, pp.None, 2016, https://doi.org/10.1155/2020/7984565
  6. Dynamic Changes in Coagulation Function in Patients With Pneumonia Under Admission and Non-admission Treatment vol.8, pp.None, 2021, https://doi.org/10.3389/fmed.2021.626384
  7. Thrombosis associated with mycoplasma pneumoniae infection (Review) vol.22, pp.3, 2016, https://doi.org/10.3892/etm.2021.10399
  8. The Value of High-Resolution Vessel Wall Magnetic Resonance Imaging in the Diagnosis and Management of Primary Angiitis of the Central Nervous System in Children vol.29, pp.4, 2016, https://doi.org/10.26815/acn.2021.00437