Mycoplasma-induced minimally conscious state

Horvath, Thomas; Fischer, Urs; Müller, Lionel; Ott, Sebastian Robert; Bassetti, Claudio; Wiest, Roland; Sendi, Parham; Schefold, Joerg C. (2016). Mycoplasma-induced minimally conscious state. SpringerPlus, 5, p. 143. Springer 10.1186/s40064-016-1832-2

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Mycoplasma pneumoniae (M. pneumoniae) frequently causes community-acquired respiratory tract infection and often presents as atypical pneumonia. Following airborne infection and a long incubation period, affected patients mostly suffer from mild or even asymptomatic and self-limiting disease. In particular in school-aged children, M. pneumoniae is associated with a wide range of extrapulmonary manifestations including central nervous system (CNS) disease. In contrast to children, severe CNS manifestations are rarely observed in adults. We report a case of a 37 year-old previously healthy immunocompetent adult with fulminant M. pneumoniae-induced progressive encephalomyelitis who was initially able to walk to the emergency department. A few hours later, she required controlled mechanical ventilation for ascending transverse spinal cord syndrome, including complete lower extremity paraplegia. Severe M. pneumoniae-induced encephalomyelitis was postulated, and antimicrobial, anti-inflammatory and immunosuppressive therapy was applied on the intensive care unit. Despite early and targeted therapy using four different immunosuppressive strategies, clinical success was limited. In our patient, locked-in syndrome developed followed by persistent minimally conscious state. The neurological status was unchanged until day 230 of follow-up. Our case underlines that severe M. pneumoniae- related encephalomyelitis must not only be considered in children, but also in adults. Moreover, it can be fulminant and fatal in adults. Our case enhances the debate for an optimal antimicrobial agent with activity beyond the blood-brain barrier. Furthermore, it may underline the difficulty in clinical decision making regarding early antimicrobial treatment in M. pneumoniae disease, which is commonly self-limited.

Item Type:

Journal Article (Further Contribution)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology

UniBE Contributor:

Horvath, Thomas; Fischer, Urs; Müller, Lionel; Ott, Sebastian Robert; Bassetti, Claudio; Wiest, Roland; Sendi, Parham and Schefold, Joerg C.

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2193-1801

Publisher:

Springer

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

07 Jun 2016 15:55

Last Modified:

03 May 2017 08:44

Publisher DOI:

10.1186/s40064-016-1832-2

PubMed ID:

27026840

Uncontrolled Keywords:

Atypical pneumonia; Coma; Encephalitis; ICU; Mycoplasma pneumoniae; Myelitis

BORIS DOI:

10.7892/boris.80873

URI:

https://boris.unibe.ch/id/eprint/80873

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