Korean J Crit Care Med.  2017 May;32(2):211-217. 10.4266/kjccm.2016.00283.

Extensive and Progressive Cerebral Infarction after Mycoplasma pneumoniae Infection

• Choi YH
• Jeong HJ
• Lee B
• An HY
• Lee EJ
• Park JD

• KMID: 2384047
• DOI: http://doi.org/10.4266/kjccm.2016.00283

Abstract

Acute cerebral infarctions are rare in children, however, they can occur as a complication of a Mycoplasma pneumoniae (MP) infection due to direct invasion, vasculitis, or a hypercoagulable state. We report on the case of a 5-year-old boy who had an extensive stroke in multiple cerebrovascular territories 10 days after the diagnosis of MP infection. Based on the suspicion that the cerebral infarction was associated with a macrolide-resistant MP infection, the patient was treated with levofloxacin, methyl-prednisolone, intravenous immunoglobulin, and enoxaparin. Despite this medical management, cerebral vascular narrowing progressed and a decompressive craniectomy became necessary for the patient's survival. According to laboratory tests, brain magnetic resonance imaging, and clinical manifestations, the cerebral infarction in this case appeared to be due to the combined effects of hypercoagulability and cytokineinduced vascular inflammation.

Keyword

cerebral infarction; child; mycoplasma pneumoniae; thrombosis; vasculitis

MeSH Terms

Brain
Cerebral Infarction*
Child
Child, Preschool
Decompressive Craniectomy
Diagnosis
Enoxaparin
Humans
Immunoglobulins
Inflammation
Levofloxacin
Magnetic Resonance Imaging
Male
Mycoplasma pneumoniae*
Mycoplasma*
Pneumonia, Mycoplasma*
Stroke
Thrombophilia
Thrombosis
Vasculitis
Enoxaparin
Immunoglobulins

Figure

• 

  Figure 1. Chest radiogram on the day of admission shows consolidation and atelectasis in the right upper and left lower lung.

• 

  Figure 2. Magnetic resonance imaging (MRI) performed at the previous hospital on the day of admission. Axial section of diffusion-weighted MRI showing an area of restricted diffusion in the left thalamus (A), pons, and bilateral cerebellum (arrow) (B). Axial section of the apparent diffusion map showing a corresponding low apparent diffusion coefficient value in the left thalamus (arrow) (C), pons, and bilateral cerebellum (arrow) (D).

• 

  Figure 3. Magnetic resonance angiography (MRA) performed at the previous hospital on the day of admission. MRA image showing a filling defect (A) in the right vertebral artery (arrow) and (B) basilar artery (arrow) suggestive of thrombosis.

• 

  Figure 4. Magnetic resonance angiography image showing multifocal narrowing in both the middle cerebral artery and internal carotid artery (arrow) suggestive of vasculitis.

Reference

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