Was the occurrence of mycoplasma pneumoniae pneumonia combined with cerebral watershed infarction a coincidence?: A CARE compliant case series and literature review.

Yuan-Yuan Wang, Jun-Ling Cui, Feng Mo, Ge-Fei Li

Journal: Medicine 2025;104(50):e46541

PMID: 41398820

Abstract

RATIONALE

Mycoplasma pneumoniae (MP) is one of the most common respiratory pathogens in children. The prevalence of MP-induced pneumonia (MPP) has increased significantly in China since the outbreak of pediatric respiratory diseases in 2023. MP can affect almost every organ system in the body. The incidence of cerebral infarction in MPP is relatively rare, and the mechanisms involved in the occurrence of MPP with cerebral infarction are not completely clear.

PATIENT CONCERNS

The clinical data of children with MPP admitted to Hebei Children's Hospital between January 2018 and January 2024 who developed cerebral infarction during the acute stage were reviewed. Cerebral magnetic resonance imaging revealed cerebral watershed infarction in all 4 children included in the study. The thrombi were detected in other arteries in Cases 1 and case 4, and both of them tested positive for MP-PCR in their cerebrospinal fluid. Cases 2 and case 3 underwent fibrebronchoscopy under basic anesthesia and developed hemiplegia 2 hours and 1 day postoperatively, respectively.

DIAGNOSES

Based on the clinical manifestations and laboratory test results, 4 patients could be diagnosed with MPP. These children exhibited positive neurological symptoms during the acute stage of pneumonia, considering the characteristics of the brain magnetic resonance imaging, cerebral watershed infarction can be diagnosed simultaneously.

INTERVENTIONS

Patient 1 and 3 received urokinase thrombolytic therapy, and was also treated with heparin sodium and aspirin for anticoagulation. Patient 2 used a combination of heparin calcium and aspirin to achieve the anticoagulant effect. Patient 4 was treated with calcium heparin for anticoagulation.

OUTCOMES

Patient 1 and Patient 4 returned to the baseline level 1 week after the onset of the disease, while Patient 2 and Patient 3 recovered to a roughly normal state within 1 to 2 months after the onset.

LESSONS

Focal vasculitis, hypercoagulability and hypoperfusion may be the dominant causes of cerebral watershed infarction in patients with MP infection.

Address: Department of Neurology, Hebei Key Laboratory of Pediatric Epilepsy, Hebei Provincial Clinical Research Center for Child Health and Disease, Hebei Children's Hospital, Shijiazhuang, Hebei Province, China.; Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.; Department of Neurosurgery, Hebei Provincial People's Hospital, Shijiazhuang, Hebei Province, China.

DOI: 10.1097/MD.0000000000046541

MeSH Terms: Humans, Pneumonia, Mycoplasma, Cerebral Infarction, Male, Female, Child, Mycoplasma pneumoniae, Child, Preschool, Magnetic Resonance Imaging, China