Abstract
BackgroundMycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well. Complications of M.pneumoniae infections include CNS involvement but other as pericarditis were also reported. The lack of feasible culture methods and under appreciation of the pathogens ability to cause invasive disease leads to reduced number of diagnosed M.pneumoniae related complications. In contrast to many other respiratory pathogens causing pneumonia, M. pneumoniae related severe pleural complications were almost never reported.Case presentationWe report a previously healthy 57 years old woman presented with indolent massive right pleural effusion, leukocytosis and elevated ESR. Extensive microbiological evaluation didn't reveal any pathogen in the pus even before antibiotic treatment was started. Surprisingly, M.pneumoniae DNA was detected in the pus from the empyema using PCR designed to detect M.pneumoniae. A serological assay (Serodia-Myco II) using convalescent serum was indeterminate with a titer of 1:80. The patient responded well to a treatment that included right thoracotomy with pleural decortication and a combination of antibiotics and anti-inflammatory medications.ConclusionM.pneumoniae related empyema was never reported before in adult patients and was reported in only a few pediatric patients. In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment. The only pathogen detected was M.pneumoniae. In this patient, serology was not helpful in establishing the diagnosis of M.pneumoniae related diseases, as was suggested before for older patients. We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods.
Highlights
Mycoplasma pneumoniae is responsible for more than 20% of community acquired pneumonia cases, and capable of causing upper respiratory illness as well
In our patient there was no evidence to any common pathogens even before initiating antibiotic treatment
We suggest that M.pneumoniae related empyema is probably under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods
Summary
In this case report we describe the first reported empyema caused by Mycoplasma pneumoniae in an adult. We suggest that M.pneumoniae related empyema is probably an under-diagnosed complication due to insensitivity of serology in older patients and under use of other diagnosis methods. Few severe cases with significant pleural effusion and necrotizing pneumonia were reported in children [8]. Two studies in these pediatric patients suggested that at least two distinct patterns of M.pneumoniae related pleural effusion [9,10]: the first is more benign, most probably reactive and does not contain M.pneumoniae DNA. The other, involves protracted disease and contains M.pneumoniae DNA. No reports describing M.pneumoniae associated empyema in adult or elderly patients were found
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