Koike Yuji, Aoki Nao
Department of Pediatrics, Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan.
Case Rep Pediatr. 2013;2013:586705. doi: 10.1155/2013/586705. Epub 2013 Jul 18.
Mycoplasma pneumoniae (Mp) sometimes causes immunological complications in children. We present a rare case of hemophagocytic syndrome (HPS) caused by Mp in a previously healthy 7-year-old Japanese girl. A chest radiograph obtained to evaluate the source of her fever showed infiltration in the lower right lung with mild splenomegaly. We could diagnose the patient with HPS on the basis of the hemophagocytic-lymphohistiocytosis- (HLH) 2004 criteria. She met the criteria for fever, splenomegaly, neutrophil count (<1,000/ μ L), platelet count (<10.0 × 10(4)/ μ L), fasting triglyceride level (>265 mg/dL), and ferritin level (>500 ng/mL). Furthermore, a peripheral blood smear showed an increased number of monocytes/macrophages with erythrophagocytosis. Treatment with clarithromycin and prednisolone, which was initiated soon after the diagnosis, was successful. Mp infection might partly progress to HPS in certain conditions. Clinicians should be aware of HPS caused by Mp and start appropriate treatment as soon as possible if the disease is suspected.
肺炎支原体（Mp）有时会在儿童中引发免疫并发症。我们报告了一例罕见的噬血细胞综合征（HPS），该病例发生在一名此前健康的7岁日本女孩身上，由Mp感染所致。为评估其发热病因所做的胸部X光片显示右下肺有浸润影，伴有轻度脾肿大。我们依据噬血细胞性淋巴组织细胞增生症（HLH）2004标准诊断该患者患有HPS。她符合发热、脾肿大、中性粒细胞计数（<1000/μL）、血小板计数（<10.0×10⁴/μL）、空腹甘油三酯水平（>265mg/dL）以及铁蛋白水平（>500ng/mL）等标准。此外，外周血涂片显示单核细胞/巨噬细胞数量增加且存在红细胞吞噬现象。诊断后不久开始使用克拉霉素和泼尼松龙进行治疗，治疗取得了成功。在某些情况下，Mp感染可能部分进展为HPS。临床医生应意识到由Mp引起的HPS，并且如果怀疑该病，应尽快开始适当治疗。
