Hepatitis Complicated with Mycoplasma pneumoniae Infection in Children

Lee, Seung Min; Lee, Sung Moon; Tchah, Hann; Jeon, In Sang; Ryoo, Eell; Cho, Kang Ho; Seon, Yong Han; Son, Dong Woo; Hong, Hee Joo

Abstract

PURPOSE
Mycoplasma pneumoniae infection is relatively common in childhood. Its extrapulmonary manifestations have been reported so much, but hepatitis associated with it has been reported rarely in Korea. METHODS: A clinical study was performed on 556 patients of M. pneumoniae pneumonia diagnosed serologically at Gil hospital from January 2001 to December 2004. We reviewed 65 cases among these patients, who had elevated level of serum AST and ALT greater than 50 IU/L respectively without evidence of hepatitis A, B, C, Cytomegalovirus and Ebstein-Barr virus infections. RESULTS: Hepatitis occurred in 11.7% of Mycoplasma pneumoniae pneumonia, especially in fall and winter times. Male to female ratio was 1.2: 1 and the mean age was 4 years and 3 months. Besides hepatitis, cough (95.4%), sputum (52.3%) and dyspnea (12.3%) were common as pulmonary manifestations. And among gastrointestinal manifestations, nausea/vomiting (26.2%) was the most common symptom, followed by poor oral intake (12.3%), diarrhea (12.3%) and abdominal pain (6.2%). In addition to hepatomegaly (4.6%) and splenomegaly (4.6%), coarse breathing sound was the most common physical manifestation, followed by rale (63.1%), pharyngeal injection (26.2%), and rash (10.8%). Anemia was noted in 20.0%, neutrophilia in 10.8%, eosinphilia in 38.5% and thrombocytosis in 6.2%, respectively. Mean level of ESR and CRP was 32.02 mm/hr and 6.69 mg/dL, respectively. Mean level of AST and ALT was 293.80 IU/L and 181.48 IU/L, respectively. Hyperbilirubinemia was noted in 7.7% and hypoalbuminemia was noted in 58.5%. Lobar or lobular pneumonia (78.5%) was the most common finding in chest X-ray and left lower lobe (39.2%) was most commonly affected. Pleural effusion was noted in 26.2%. Mean duration of hospitalization was 9.91 days. Serum AST/ALT level was normalized within 9.94 days and pulmonary consolidation resolved within 14.29 days. CONCLUSION: The prognosis of M. pneumoniae hepatitis is good. However, liver function should be considerately checked in M. pneumoniae infection because its incidence is not so low.