MYCOPLASMA PNEUMONIAE PNEUMONIA – A CASE SERIES REPORT

Abstract

Introduction: Mycoplasma pneumoniae is one of the main causes of community-acquired pneumonia in children. In recent years, there has been a global increase in severe cases that often do not respond to the standard beta-lactam antibiotics usually initially used for treatment of community-aquired pneumonia. The pathogenesis of these forms is caused by the citotoxic effect of the CARDS toxin and a dysregulated immune response, which leads to serious lung and extrapulmonary complications. Early recognition of atypical clinical presentations and starting the right therapy on time is key to preventing permanent lung damage.

Case Series: We presented three pediatric cases treated in 2025 at the Hospital for Pediatric Lung Diseases and Tuberculosis. Case 1, an 18 years old adolescent, shows an atypical presentation with pneumonia and suspected MIRM syndrome (Mycoplasma-induced rash and mucositis), with dry cracked lips, a buccal aphthous lesion, and a morbilliform rash later in the treatment. Case 2, a 9 years old girl, shows M. pneumoniae as a trigger for asthma exacerbation and the development of pleural effusion during treatment, after initial improvement. Case 3, a 11 years old girl, highlights the importance of lung ultrasound in detecting bilateral pleural effusion in previously healthy children. In all cases, initial oral therapy with amoxicillin+clavulanic acid and cefixime was not effective. Rapid improvement and regression of complications were achieved by introducing macrolides combined with parenteral cephalosporins and systemic corticosteroids, along with supportive and symptomatic therapy.

Discussion: The analysis of this case series shows that M. pneumoniae is no longer just a cause of mild infections; it can manifest with severe lung complications like pleural effusion and also with strong immune responses outside the lungs.

Conclusion: The current epidemiological wave requires a high level of suspicion for atypical etiology in children with a persistent cough, long-lasting fever, or sudden respiratory worsening. Prompt radiological evaluation, detection of the pathogen, and a more aggressive therapeutic approach are key steps for successful treatment and the prevention of sequelae.