pISSN 2093-2340   eISSN 2092-6448
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    Infect Chemother. 2009 May-Jun;41(3):190-195. Korean.
    Published online Jun 30, 2009.
    https://doi.org/10.3947/ic.2009.41.3.190
    Copyright © 2009 The Korean Society of Infectious Diseases and The Korean Society for Chemotherapy
    Case Report

    Corticosteroid Treatment in Siblings Affected with Severe Mycoplasma pneumoniae Pneumonia

    Do-Hee Kim, M.D.,1 Kyung-Yil Lee, M.D.,1 Myung-Sook Kim, M.D.,2 You-Sook Youn, M.D.,1 Ja-Young Hwang, M.D.,1 Jung-Woo Rhim, M.D.,1 Jin-Han Kang, M.D.,1 and Joon-Sung Lee, M.D.1
      • 1Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea.
      • 2Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
    • Correspondence author: Kyung-Yil Lee, M.D. Department of Pediatrics, The Catholic University of Korea, Daejeon St. Mary's Hospital, 520-2 Daeheung-dong, Jung-gu, Daejeon 301-723, Korea. Tel:+82-42-220-9541, Fax:+82-42-221-2925, Email: leekyungyil@catholic.ac.kr
    Received January 08, 2009; Accepted April 06, 2009.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Numerous evidences support the pathogenesis that M. pneumoniae pneumonia is associated with cell-mediated immune reaction. We report 2 cases of severe M. pneumoniae pneumonia in previously healthy sisters, who were both admitted during an epidemic of M.pneumoniae pneumonia. The elder sister, who was 16 years old, was admitted with M. pneumoniae pneumonia. She showed no response to treatment with clarithromycin and levofloxacin, and eventually progressed to severe ARDS, requiring mechanical ventilation. After treatment with hydrocortisone (200 mg/day), there were rapid improvements in clinical manifestations and chest radiographic findings. The younger sister, who was 14 years old, was admitted 10 days later, presenting with fever but no pneumonic lesions on chest radiograph. Just like her sister, the infection showed no response to clarithromycin. Fever persisted and pneumonic consolidation with mild pleural effusion was noticed in the left lower lobe on the 5th hospital-day. After treatment with oral prednisolone (1 mg/kg), she showed rapid defervescence and on the 8th hospital day, no pneumonic lesions were detectable on chest radiograph. Given the fact that the pathogenesis of pneumonia and extrapulmonary manifestations in M. pneumoniae infection is immune-mediated, an immunosuppressive therapy would be validated for selected patients with M. pneumoniae infections.

    Keywords
    Mycoplasma pneumoniae; Pneumonia; Corticosteroids

    Figures

    Figure 1
    Chest X-ray findings of case-1. A) Initial chest radiograph shows multifocal pneumonic consolidations in both lung fields with left pleural effusion. B) Further progression of extensive pneumonic consolidations and pleural effusion in both lung fields are present on the 3rd hospital day. C) Chest X-ray shows markedly improved lung lesions after corticosteroid therapy on the 8th hospital day.

    Figure 2
    Chest X-ray findings of case-2. A) Initial chest radiograph shows no definitive pneumonic consolidation in both lung fields except suspicious increased density on left retrocadiac region. B) Fine reticular pneumonic consolidation in left lower lobe with mild blunting of costopleural angle is shown on the 4th hospital day. C) There is resolution of pneumonic consolidation after corticosteroid therapy on the 7th hospital day.

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    MeSH Terms
    Adrenal Cortex Hormones
    Clarithromycin
    Fever
    Humans
    Hydrocortisone
    Mycoplasma
    Mycoplasma pneumoniae
    Ofloxacin
    Pleural Effusion
    Pneumonia
    Pneumonia, Mycoplasma
    Prednisolone
    Respiration, Artificial
    Siblings
    Thorax
    Metrics
    Share
    Figures
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