- 期刊
Mycoplasma Pneumonia Complicated with Cold Agglutinin Hemolysis, Ischemic Stroke, and Acute Kidney Injury in a Middle-Aged Woman with Type II Diabetes: A Case Report and Literature Review
第二型糖尿病中年女性之黴漿菌肺炎併發冷凝集素溶血性貧血，缺血性中風，及急性腎衰竭：病例報告和文獻回顧
摘要
Mycoplasma pneumoniae is an essential common human pathogen in the etiology of atypical pneumonia in children and adults. In some rare instances, however, it might result in secondary cold agglutinin disease (i.e., cold agglutinin-associated autoimmune hemolytic anemia) or ischemic stroke. We report a case of the 47-year-old woman with type II diabetes mellitus who was diagnosed as having Mycoplasma pneumonia as the result of positive mycoplasma IgM antibody and cold agglutinin tests. Complications including severe hemolytic anemia, jaundice, ischemic stroke due to RBC cold agglutination, and acute kidney injury occurred later. Under treatment with levofloxacin, plasmapheresis and hemodialysis, she recovered gradually and could carry out daily activities independently. This case shows that mycoplasma pneumonia can lead to complications with extrapulmonary diseases involving a wide variety of organs. Multiple extrapulmonary manifestations often indicate an ominous prognosis. In clinical practice, even though mycoplasma infection is common, the extrapulmonary manifestations should be evaluated and managed seriously.
並列摘要
黴漿菌，從兒童至成人，是導致非典型肺部感染的重要致病原之一。稀少的病例顯示黴漿菌會導致冷凝集疾病（如：冷凝集相關之自體免疫溶血性貧血）或是缺血性中風。本文報告一位47歳中年婦女，本身為糖尿病患者，臨床上出現發燒，咳嗽，流鼻水，以及胸部X光片上有一肺炎浸潤。經過10天的治療後，咳嗽持續惡化並合併再次發燒。因黴漿菌血清學抗體檢驗及冷凝集測試均呈現陽性，因此確立黴漿菌肺炎診斷。臨床上，更發生嚴重之溶血性貧血，黃膽，併發右側肢體無力，中風及急性腎衰竭。該病患在完整的抗生素治療，血漿置換，及血液透析治療下，病情獲得明顯改善，逐漸復原並能恢復其日常之行動功能。該病例說明黴漿菌肺炎可能涉及肺外多重器官的複雜疾病。多重肺外器官表現通常代表不良預後。在臨床診療上，即使黴漿菌感染很常見，也應該審慎評估及處理黴漿菌感染的肺外表現。