Fatal thrombocytopenia associated with Mycoplasma pneumoniae infection

Immune thrombocytopenia associated with Hashimoto thyroiditis in a pediatric patient: A case report

RATIONALE

Immune thrombocytopenia (ITP) is one of the most commonly acquired bleeding diseases in children. Infection and autoimmune disorders are the most common causes of ITP. The pathogenic mechanism of ITP is complex and is not completely understood. Understanding the underlying causes or disorders of ITP will improve the prognosis and make therapy more targeted.

PATIENT CONCERNS

An 8-year-old girl with ITP responded poorly to first- and second-line treatment. The patient showed multiple scattered petechiae, ecchymoses, and purpura in the skin and blood clots in the oral mucous membrane.

DIAGNOSES

The patient was diagnosed with ITP associated with Hashimoto thyroiditis.

INTERVENTIONS

The patient was admitted to our emergency department and received platelet transfusion, IVIG, glucocorticoids and eltrombopag. The patient's thrombocytopenia resolved within 18 days after the administration of levothyroxine treatment.

OUTCOMES

The patient was diagnosed with Hashimoto thyroiditis, and the platelet count recovered on the 3rd day of levothyroxine treatment. The platelet count became steadily normal with levothyroxine and prednisone treatment within 2 months of follow-up.

LESSONS

Early identification of the underlying reasons and treatment with multiple modalities may be useful in improving the prognosis of ITP. The treatment of thyroid disease and restoration of the euthyroid state impact the clinical outcome of ITP in children.

Immune Thrombocytopenia Associated with Mycoplasma pneumoniae Infection

Immune thrombocytopenia (ITP) related to Mycoplasma pneumoniae infection is a rare condition and usually associated with a severe clinical course. We here report a case of a young man with a clinical diagnosis of severe ITP secondary to M. pneumoniae infection. The clinical features, therapy and outcome are presented.

The ischaemic ECG: is it all in the head?

Acute cerebrovascular events including ischaemic stroke and subarachnoid haemorrhage are known to be associated with left ventricular dysfunction and significant electrocardiographic abnormalities that can mimic cardiac ischaemia. The authors present a case in which an intracerebral haemorrhage was diagnosed during the treatment of pneumonia in a 62-year-old woman, with repolarisation abnormalities on the ECG acting as the key diagnostic clue in the absence of clinical or radiological evidence of ventricular dysfunction. The pneumonia was treated without complication, and there were no long-term respiratory, cardiac or neurological sequelae. Diagnostic cardiac imaging, including angiography at follow-up, confirmed the absence of significant coronary artery disease, suggesting a non-coronary aetiology for these ECG changes. The authors emphasise that when presentation is atypical for acute coronary syndrome, non-specific ECG changes could point to a primary cerebrovascular pathology, even in the absence of neurological or cardiac symptoms.

Mycoplasma pneumonia Infection: A Possible Trigger for Immune Thrombocytopenia

Mycoplasma pneumonia (M. pneumonia) is usually not considered among the several pathogens that induce immune thrombocytopenia (ITP). We report a child with a clinical diagnosis of severe ITP that was associated with M. pneumonia pneumonia, and review the few cases described in the English literature. We suggest that thrombocytopenia associated with M. pneumonia infection may constitute a subset of ITP, although unlike ITP it occurs concomitantly with the infection and tends to be more severe than "classic" ITP. We recommend that prompt specific antibiotic and immune modulating treatment should be initiated in appropriate clinical settings.

Mycoplasma pneumoniae infection associated with pancytopenia: a case report

Immune hemolytic anemia is a rare condition in childhood. Cold agglutinins have been implicated in the etiology of the hemolysis and frequently observed during Mycoplasma pneumoniae infections. We present here a case of cold agglutinin-related hemolytic anemia, thrombocytopenia, and leukopenia secondary to M. pneumoniae associated pneumonia. It is suggested that even though very rare, M. pneumoniae infection should be considered as the underlying disease in a patient presenting with pancytopenia.

Erosive polyarthritis associated with Mycoplasma gateae in a cat

Erosive polyarthritis was diagnosed in an 11-month-old neutered male Egyptian Mau-cross cat with concurrent glucocorticoid-responsive dermatitis. Clinical signs, synovial fluid analysis, serological tests and radiographic appearance could not differentiate between immune-mediated and infective arthritis. Mycoplasma gateae was isolated by strictly anaerobic culture of the synovial fluid. Treatment with Enrofloxacin led to a rapid improvement of the cat's condition. Two months later the cat was euthanased because of severe glomerulonephritis and direct Coombs' test positive anaemia, possibly caused by mycoplasma infection. M gateae could not be isolated at post-mortem examination.

[Autoantibodies and anti-factor VIII and Chlamydia pneumoniae infection]

We report the case of a 64-year-old man without hemorrhagic history experiencing epistaxis. The standard hemostasis assessment including prothrombin index, activated partial thromboplastin time (APTT) and platelet count found an isolated abnormal APTT (105 sec vs 33 sec). Therefore, coagulation factors were explored. An acquired factor VIII deficiency (5%) with anti-FVIII antibody (4.5 Bethesda unit.mL-1) was recognised. This anti-FVIII antibody was related to a Chlamydia pneumoniae pulmonary infection. Treatment consisted of: i) Four successive anterior packing and activated factor VII infusion (Novoseven); ii) steroids injection and bi-antibiotherapy. The time course of the epistaxis was favourable under treatment.