MYCOPLASMA PNEUMONIAE-INDUCED RHABDOMYOLYSIS AND PERI-MYOCARDITIS

Abstract

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mycoplasma pneumoniae (MP) is a common cause of community acquired pneumonia with an incidence of 1-3 per 1000 cases annually [1]. However, extrapulmonary manifestations of MP in the adult population are rare [3]. The mechanism behind injury is predicted to be caused by bacterial inflammation and vascular occlusion combined with an autoinflammatory response [2]. We present a case of a 21-year-old Hispanic male with rhabdomyolysis and peri-myocarditis caused by MP. CASE PRESENTATION: A 21-year-old Hispanic male with a past medical history of Kawasaki disease presented complaining of constant chest pain for two days. He endorsed subjective fever, dark urine, and myalgias. He had previously visited an urgent care and was prescribed ibuprofen and cyclobenzaprine to no avail. On physical exam, the patient was afebrile and tachypneic. Cardiac exam revealed tachycardia with no rubs, murmurs, or gallops. Lung fields were clear to auscultation bilaterally. Chest pain was not reproducible upon palpation. The abdomen was soft, nondistended, and without organomegaly. Initial labs revealed leukocytosis, transaminitis, elevated d-dimer, elevated troponins, elevated C-reactive protein, and elevated creatinine kinase. Admission chest x-ray was without infiltrates, cardiomegaly, or pneumothorax. Initial electrocardiogram demonstrated ST elevations in inferolateral leads. Emergent cardiac catheterization demonstrated normal coronary anatomy. CTA of the chest was negative for pulmonary embolism and aortic dissection. Original echocardiogram demonstrated normal ejection fraction. Respiratory pathogen panel was positive for MP IgM. Treatment for MP-induced rhabdomyolysis and peri-myocarditis with intravenous fluids and azithromycin was initiated. He experienced a transient systolic heart failure, managed with Bilevel Positive Airway Pressure. The rapid clearance of bacteria with proper antibiotics allowed the stunned myocardium to recuperate within 72 hours. At which point the patient experienced rapid clinical improvement and was discharged home in stable condition. DISCUSSION: The diagnosis of MP is difficult due to its cellular structure, its ability to be missed on routine blood cultures, and its ability to cause extrapulmonary manifestation via autoimmune dysfunction [2]. The case demonstrates a patient with rhabdomyolysis and peri-myocarditis with positive MP IgM. The patient also experienced rapid clinical improvement with clearance of bacteria by antibiotic administration. Thus, we were able to diagnose another rare manifestation of a MP infection causing rhabdomyolysis and peri-myocarditis. CONCLUSIONS: MP is difficult to isolate and has the ability to present with myriad symptomatology. Although MP is difficult to diagnose, it is easily treated. Therefore, MP should be considered in young patients due to its increased incidence in the younger population and unique presentations. REFERENCE #1: Foy, H. M., Kenny, G. E., Cooney, M. K., & Allan, I. D. (1979). Long-Term Epidemiology of Infections with Mycoplasma pneumoniae. Journal of Infectious Diseases, 139(6), 681–687. https://doi.org/10.1093/infdis/139.6.681 REFERENCE #2: Narita, M. (2016). Classification of Extrapulmonary Manifestations Due to Mycoplasma pneumoniae Infection on the Basis of Possible Pathogenesis. Frontiers in Microbiology, 7. https://doi.org/10.3389/fmicb.2016.00023 REFERENCE #3: Khan, F. Y., & Sayed, H. (2012). Rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia. Hong Kong medical journal, 18(3), 247–249. DISCLOSURES: No relevant relationships by Taleb El-Masri, source=Web Response No relevant relationships by Alex Morizio, source=Web Response No relevant relationships by Tram Nguyen, source=Web Response No relevant relationships by Elena Tellez, source=Web Response No relevant relationships by Yaswanraj Yuvaraj, source=Web Response