Journal of Shandong University (Health Sciences) ›› 2023, Vol. 61 ›› Issue (11): 96-103.doi: 10.6040/j.issn.1671-7554.0.2023.0377

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Clinical analysis of 9 cases of mycoplasma pneumoniae pneumonia complicated with pulmonary embolism in children and literature review

SONG Shaoxiu, XU Yongsheng   

  1. Department of Respiratory, Tianjin Childrens Hospital, Tianjin 300400, China
  • Published:2023-12-12

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Abstract: Objective To analyze the clinical characteristics and treatment of mycoplasma pneumoniae pneumonia(MPP)complicated with pulmonary embolism(PE)in children. Methods The general data, clinical manifestations, laboratory tests, imaging features, treatment and prognosis of 9 cases of children with MPP complicated with PE treated during Jan. 2018 and Dec. 2021 were retrospectively analyzed, and relevant literature was reviewed. Results The median age of patients was 3-8 years, with a median of 7.5 years; the median days from onset to PE was 14 days. All cases were refractory MPP(RMPP). Chest pain occurred in 3 cases, hemoptysis in 1 case, dyspnea in 5 cases, and radiating pain at atypical sites in 6 cases. The C-reactive protein(CRP), D-dimer and fibrinogen(FIB)increased in all cases; the platelet(PLT)count and IL-6 levels increased in 7 cases. Screening of thrombophilia-related indexes showed 5 cases of positive lupus anticoagulant(LA), 5 cases of positive anti-cardiolipin antibody(ACA), 3 cases of positive anti-β2-glycoprotein antibody IgM, 3 cases of reduced protein S activity, 3 cases of elevated coagulation factor VIII, and 6 cases of positive antinuclear antibody. CT pulmonary arteriogram showed filling defects at the embolization site with pleural effusion. All cases were positive for bronchoalveolar lavage fluid resistance mutation site 2063/2064. After treatment with sequential low-molecular heparin anticoagulation plus rivaroxaban, all patients recovered well, and 2 children with cardiac embolism received thrombolysis. During the follow-up of 0.5-9 months, all children had slow absorption of emboli, no recurrence occurred, and the autoantibodies and thrombophilia indexes returned to normal. Conclusion MPP complicated with PE is mostly RMPP cases. The onset of PE does not necessarily coincide with the extreme stage of disease. Most patients will have transient autoantibody positivity, leading to imbalance of coagulation and anticoagulation fibrinolytic system. Timely treatment will result in good prognosis, and rivaroxaban is effective in the treatment of the disease.

Key words: Children, Mycoplasma pneumoniae pneumonia, Pulmonary embolism, Treatment

CLC Number: 

  • R725
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