614 - Managing Severe Mycoplasma Induced Rash, Mucositis, Hemolysis, and Colonic Pseudo-Obstruction: Therapeutic Challenges in a Pediatric Patient

Publication Number: 614.5602

Ilham Farhat, Rutgers Health, Children's Hospital of New Jersey at NBI, Parlin, NJ, United States; Suman Dhakal, Rutgers/Newark Beth Israel Medical Center, Springfield, NJ, United States; Leonard Emuren, Rutgers New Jersey Medical School, 201 Lyons Ave, NJ, United States; Bhavik Patel, Children’s Hospital of New Jersey , Newark Beth Israel Medical Center, Newark, NJ, United States

Background: Mycoplasma pneumoniae is a common cause of respiratory illness in children but may present with rare extra-pulmonary manifestations such as Mycoplasma induced rash and mucositis (MIRM), and cold agglutinin-induced hemolysis. We report managing a severe case in a 10-year-old male with severe MIRM, hemolysis, and acute colonic pseudo-obstruction (Ogilvie syndrome) during the course of his illness to highlight treatment complexities.

Objective: To report and discuss the multidisciplinary management of a child with Mycoplasma pneumoniae infection, complicated by MIRM, hemolysis, and Ogilvie syndrome, emphasizing the importance of timely diagnosis and intervention for favorable outcomes.

Design/Methods: A 10-year-old male with history of chronic constipation presented with a 2-day history of fever, cough, oral swelling, and blistering rash. He developed worsening mucositis, hemolysis confirmed by positive cold agglutinin antibodies, and acute colonic pseudo-obstruction. Management included azithromycin, steroids, IVIG, and blood transfusions. Multidisciplinary care involving nephrology, infectious diseases, hematology, gastroenterology, and surgery was required for bowel decompression via rectal tube placement and total parenteral nutrition (TPN) due to oral mucositis and gastrointestinal dysfunction.

Results: The patient’s hemoglobin dropped from 9.8 g/dL to 7.3 g/dL, with LDH 1481 U/L and indirect hyperbilirubinemia, consistent with hemolysis. He required blood transfusions for anemia in the setting of ongoing hemolysis and 2 doses of IVIG due to worsening mucositis while on high-dose steroids. Imaging revealed significant colonic distension (cecum 7.1 cm, sigmoid 8.3 cm), necessitating rectal tube placement. Abdominal distension improved, and the patient transitioned from TPN to a regular diet. After 16 days, including 6 days in the PICU, he was discharged on a steroid taper since he had been on high dose steroids.

Conclusion(s): This case highlights the importance of early recognition and aggressive management of severe systemic complications in pediatric Mycoplasma pneumoniae infections. While it remains uncertain if the hemolysis and acute colonic pseudo-obstruction were directly related to Mycoplasma infection or secondary to treatment interventions, this case still highlights the importance of a prompt and multidisciplinary approach to managing life threatening conditions, including MIRM, hemolysis, and Ogilvie syndrome.

Conjunctival Injection with Exudate
Close-up of injected conjunctiva with exudate, illustrating redness and discharge commonly seen in MIRM

Ulcerations and pealing of the lips
Ulcerations and peeling of the lips are often associated with the inflammatory process of MIRM.

Genital Lesions
A genital lesion with notable erythema, ulceration, and sloughing of the skin on the glans penis, likely consistent with MIRM

Conjunctival Injection with Exudate
Close-up of injected conjunctiva with exudate, illustrating redness and discharge commonly seen in MIRM

Ulcerations and pealing of the lips
Ulcerations and peeling of the lips are often associated with the inflammatory process of MIRM.

Genital Lesions
A genital lesion with notable erythema, ulceration, and sloughing of the skin on the glans penis, likely consistent with MIRM