Case Report

Mycoplasma pneumoniae Associated with Hemolytic Anemia, Cold Agglutinins, and Recurrent Arterial Thrombosis

Authors: Michelle L. Wilson, DO, FACP, FABHP, Eduardo Menjivar, MD, Viswanath Kalapatapu, MD, Alfred P. Hand, MD, James Garber, MD, Michael A. Ruiz, MD

Abstract

A 40-year-old white male developed Mycoplasma pneumoniae pneumonia (IgM titer 1:256) as well as autoimmune hemolytic anemia due to cold agglutinins (titer of 1:512). Four days after admission to the hospital, he developed an acute superior mesenteric artery (SMA) thrombosis. Four feet of ischemic small bowel were resected. A follow-up angiogram again showed SMA thrombosis and a left popliteal artery thrombosis. The patient was returned to the operating room and underwent thrombectomy of the affected arteries. The following day, he again developed a left popliteal artery thrombosis requiring thrombectomy. Plasmapheresis, Coumadin and prednisone were implemented. No further thrombotic events occurred. Hypercoagulability workup was negative. Pathology samples revealed vasculitis. Based on a negative hypercoagulability workup, nonrecurrence of thrombotic events after treatment, and in the absence of any structural abnormalities of the affected arteries, an autoimmune phenomenon with damage to the endothelium was thought to have played a role in the mechanism of thrombosis.


Key Points


* Mycoplasma pneumoniae represents between 7 to 20% of the causes of community-acquired pneumonia in the United States.


* Twenty-five percent of the patients develop extrapulmonary complications. Hemolytic anemia associated with multiple vascular thrombosis is a rare but severe complication ofMycoplasma pneumoniae.


* Mycoplasma pneumoniae causes disease either by direct cytotoxicity or by triggering an autoimmune response.


* An autoimmune phenomenon causing vasculitis with damage to the endothelium may have played the underlying mechanism for thrombosis.

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