Chilet Farrah, Iqbal Arshad Muhammad, Mitzov Nikolay, Eddib Abdulmagid, Muddassir Salman
Oak Hill Hospital Brooksville, 11375 Cortez Blvd, Brooksville, FL, 34613, USA.
Respir Med Case Rep. 2020 Mar 4;30:101033. doi: 10.1016/j.rmcr.2020.101033. eCollection 2020.
BACKGROUND/INTRODUCTION: Mycoplasma pneumonia affects 1% of the population in the United States. The majority of patients infected with Mycoplasma experience upper respiratory tract infection symptoms, and about 10% of patients infected with Mycoplasma develop pneumonia. A rare complication is a pulmonary embolism (PE), which may be life-threatening if not diagnosed early and treated promptly. Our case explores the presentation of Mycoplasma pneumonia complicated by acute saddle PE, an association only reported in the form of case reports globally.
A 75-year-old previously healthy female presented to the emergency department with shortness of breath. The patient was found to be in acute hypoxic respiratory failure secondary to community acquired pneumonia and antibiotics were started. During hospitalization, her respiratory failure worsened and had to be escalated to a non-rebreather mask. Repeat chest X-ray showed a possible developing infiltrate on the left side. Antibiotic coverage was escalated and broadened. Serology was positive for mycoplasma pneumoniae. Telemetry monitoring showed non-sustained episodes of Atrial Fibrillation and Electrocardiogram showed the presence of new-onset SIQIIITIII. Computer Tomography Angiography of the chest showed acute saddle PE. The patient was subsequently upgraded to the ICU, where she was intubated and started on catheter-directed thrombolysis to decrease clot burden.
To our knowledge, this is the first case of acute saddle PE in a live patient with mycoplasma pneumonia. This entity is important in order to ensure early diagnosis of PE in association with mycoplasma pneumonia and the initiation of early treatment to improve patient outcomes.
背景/引言：在美国，支原体肺炎影响着1%的人口。大多数感染支原体的患者会出现上呼吸道感染症状，约10%感染支原体的患者会发展为肺炎。一种罕见的并发症是肺栓塞（PE），如果不及早诊断和及时治疗，可能会危及生命。我们的病例探讨了支原体肺炎并发急性骑跨性肺栓塞的表现，这种关联在全球仅以病例报告的形式被报道过。
一名75岁既往健康的女性因呼吸急促被送往急诊科。该患者被发现因社区获得性肺炎继发急性低氧性呼吸衰竭，并开始使用抗生素。住院期间，她的呼吸衰竭恶化，不得不升级为非重复呼吸面罩。复查胸部X线显示左侧可能出现浸润影。抗生素覆盖范围扩大。支原体肺炎血清学检查呈阳性。遥测监测显示房颤非持续性发作，心电图显示新发SIQIIITIII。胸部计算机断层扫描血管造影显示急性骑跨性肺栓塞。该患者随后被转入重症监护病房，在那里进行了气管插管，并开始进行导管定向溶栓以减轻血栓负荷。
据我们所知，这是首例支原体肺炎患者并发急性骑跨性肺栓塞的病例。认识到这种情况对于确保与支原体肺炎相关的肺栓塞的早期诊断以及尽早开始治疗以改善患者预后非常重要。
