SHM Converge Scientific Abstract ePoster Gallery-Beyond Walking Pneumonia: A Rare Case of Mycoplasma Pneumonia Leading to Pleural Empyema

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This case report describes a rare complication of <em>Mycoplasma pneumoniae</em> infection causing pleural empyema in a 39-year-old previously healthy Hispanic woman. Although <em>Mycoplasma pneumoniae</em> commonly causes mild “walking pneumonia,” it rarely leads to severe disease or empyema.

The patient presented with 10 days of fever, chills, myalgias, cough, tachycardia, high fever, and tachypnea. Laboratory studies showed marked leukocytosis, anemia, and thrombocytosis. Chest CT demonstrated a moderate-to-large loculated left pleural effusion with right-sided infiltrates. Thoracentesis and chest tube drainage confirmed empyema. Diagnostic testing revealed <em>Mycoplasma pneumoniae</em> PCR positivity in both blood and pleural fluid, with elevated serum and pleural fluid IgM levels. Extensive testing for other causes of pneumonia, including respiratory viral panel, MRSA, pneumococcal antigen, and blood cultures, was negative, and pleural fluid cultures showed no bacterial growth.

She was diagnosed with acute hypoxic respiratory failure and sepsis secondary to <em>Mycoplasma pneumoniae</em> pneumonia complicated by empyema. Initial empiric therapy included vancomycin and meropenem, later narrowed to ampicillin-sulbactam and doxycycline, and she was discharged on levofloxacin for a 21-day course. She also received intrapleural tissue plasminogen activator (tPA) and dornase alfa, with marked clinical improvement.

The authors emphasize that although empyema is an exceedingly rare complication of <em>M. pneumoniae</em>, clinicians should consider it in patients with atypical or severe pneumonia. Early diagnosis using PCR and appropriate treatment with antibiotics plus drainage are important for favorable outcomes.

Asset Subtitle

Arthur Chidi Igbo

Meta Tag

Author List Arthur Chidi Igbo, Dipaben Patel, Kishan Talagadadeevi, Martin Marinov

Category Clinical Vignettes

Concept Mycoplasma pneumoniae

Concept Empyema

Concept Polymerase Chain Reaction

Concept Community-Acquired Pneumonia

Concept Hypoxemic Respiratory Failure

Distinguished Non-Finalist

Presenter Organization Texas Health Resources HEB/Denton Internal Medicine GME

Presenting Author Arthur Chidi Igbo

Track Adult

Keywords

Mycoplasma pneumoniae

pleural empyema

atypical pneumonia

PCR positivity

pleural effusion

sepsis

acute hypoxic respiratory failure

doxycycline

chest tube drainage

tissue plasminogen activator

Mycoplasma pneumoniae

Empyema

Polymerase Chain Reaction

Community-Acquired Pneumonia

Hypoxemic Respiratory Failure