Pediatric Mycoplasma pneumoniae Infection Presenting with Acute Cholestatic Hepatitis and Other Extrapulmonary Manifestations in the Absence of Pneumonia

Song, Won Jae; Kang, Ben; Lee, Hwa Pyung; Cho, Joongbum; Lee, Hae Jeong; Choe, Yon Ho

The main basis of treatment in cases of extrapulmonary manifestations associated with M. pneumoniae infection is antibiotics effective against the organism. Antibiotics such as macrolides should be administered to reduce the amount of M. pneumoniae infected cells in the respiratory tract, which leads to the reduction of excessive antigenic stimuli [8] . The emergence and increasing incidence of macrolide resistant M. pneumoniae strains, especially in East Asian countries, has aroused attention in the treatment of M. pneumoniae infection [19, 20] . A recent review suggested the introduction of other potentially effective antibiotics in cases of clinical deterioration of symptoms or signs despite treatment with first line macrolides, in which the choice of the replaced antibiotic should be decided according to their in vitro activity and potential adverse events [20] . Corticosteroids or immunoglobulins are suggested to be beneficial in severe cases, and anticoagulation therapy is considered highly promising for cases of vascular occlusion type manifestations [8] . In our case, early suspicion of M. pneumoniae infection based on the patient's history of mild cough, and the admin-istration of clarithromycin could have played a crucial role in the early improvement of the disease course, despite the fact that respiratory involvement M. pneumoniae seemed to be mild in our case.