A CASE OF ATAXIC GAIT SECONDARY TO MYCOPLASMA PNEUMONIA

Abstract

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Mycoplasma pneumonia infection with neurological symptoms have been described extensively in the pediatric population, but not the adult population. Here, we present a unique case of Mycoplasma pneumonia infection leading to neurological symptoms, specifically ataxia. CASE PRESENTATION: A 78-year-old male presented with 3 days of intermittent confusion and unsteady gait. He reported that he felt “wobbly” when ambulating, which was new for him as he could previously walk independently without assistance. He also reported concomitant productive cough with fever. He denied any recent trauma, changes in vision, dizziness, head/neck/back pain, tremors. He had a history of hypertension, controlled with diet and exercise. He was a nonsmoker and denied history of drug or alcohol use. On arrival, his temperature of 98.6F, pulse rate 82 beats/minute, respiratory rate 20/minute, blood pressure 145/77 mm Hg, and saturating 100% on room air. He was intermittently confused to situation otherwise oriented to self, time, and place. Diffuse areflexia was noted. He also had mild dysmetria involving the left upper extremity and ataxic staggering gait. In the next 12 hours, he developed fever with temperature of 102.7F, and tachycardia with pulse rate 110 beats/minute. Initial laboratory results including complete blood count, electrolyte levels, and renal function studies were normal. Chest X-ray reported bibasilar opacities reflective of atelectasis or pneumonia, and non-specific bilateral hilar prominence. A CT chest revealed bronchial wall thickening and airspace disease involving the right lung base possibly representing bronchopneumonia. A nasopharyngeal swab PCR was positive for Mycoplasma pneumoniae. The patient was diagnosed with Mycoplasma pneumonia complicated by neurological symptoms; specifically, delirium and ataxia. The patient was started on ceftriaxone 1 gm daily and azithromycin 500 mg daily. His neurological symptoms noticeably improved after 3 days of antibiotics with some residual gait disturbances. Spinal tap was not performed as symptoms improved significantly upon treatment with antibiotics. DISCUSSION: Mycoplasma pneumoniae infection has been reported to cause neurological symptoms either as a primary infection or associated with pulmonary infection. Encephalitis is the most frequent neurological manifestation, but meningitis, myelitis, ataxia, and psychosis have been reported. The onset of these manifestations are usually acute, and can be fatal. The pathophysiology of CNS manifestations is unknown. Besides direct invasion of Mycoplasma pneumoniae into the brain, neurotoxic or autoimmune reaction within the brain tissue is suspected. CONCLUSIONS: It is crucial to be mindful of such association since prompt and early recognition of such treatable infection would presumably improve therapeutic outcomes. Antibiotics are the mainstay of treatment. Reference #1: Clyde WA. Clinical overview of typical Mycoplasma pmeumoniae infections, Clin Infect Dis, 1993, vol. 17 Suppl 1 Reference #2: Robesrts JE, Isaacs D. Neurological and pulmonary complications of Mycoplasma pneumoniae infection ina pre-school child, J Infect, 1986, vol. 12 Reference #3: Koskiniemi M. CNS manifestations associated with Mycoplasma pneumoniae infections: summary of cases at the University of Helsinki and review, Clin Infect Dis, 1993, vol. 17 Suppl 1 DISCLOSURES: No relevant relationships by Syed Azharuddin, source=Web Response No relevant relationships by Shirin Majdizadeh, source=Web Response