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

Serum antibody and polymerase chain reaction The patient received empirical antibiotics of intravenous cefotaxime and clarithromycin, with daily supplements of fresh frozen plasma and cryoprecipitates. Fever and abdominal pain subsided on the third hospital day and laboratory exams showed gradual improvement. Although tachycardia was observed during the events of fever, blood pressure was continuously within normal range, and no oliguria was observed. Laboratory exams performed on the seventh hospital day revealed a hemoglobin of 11.8 g/dL, hematocrit 34.7%, WBC count of 7,710/mm 3 with 27% neutrophils, 49% lymphocytes, 15% monocytes, and platelet count of 278,000/mm 3 . Chemistry exams revealed a CRP level of 0.32 mg/dL (normal range, 0-0.3 mg/dL), AST of 203 IU/L (normal range, 0-40 IU/L), ALT of 281 IU/L (normal range, 0-40 IU/L), total serum bilirubin of 0.7 mg/dL (normal range, 0-1.5 mg/dL), direct serum bilirubin of 0.3 mg/dL (normal range, 0-0.5 mg/dL), total serum protein of 6.5 g/dL (normal range, 6.0-8.2 g/dL), serum albumin of 3.8 g/dL (normal range, 3.5-5.2 g/dL), CK of 457 IU/dL (normal range, 24-204 IU/dL), and LD of 3,919 IU/L (normal range, 240-480 IU/L). Coagulation studies revealed a PT of 13.0 seconds (normal range, 12.6-14.9 seconds), and 1.04 INR (normal range, 0.90-1.10 INR), aPTT of 31.1 seconds (normal range, 29.1-41.9 seconds), fibrinogen of 93 mg/dL (normal range, 182-380 mg/dL). The patient was discharged on the eighth hospital day without any complaints nor any remaining signs and symptoms.