Mycoplasma pneumoniae Pneumonia Unresponsive to Macrolide Treatment

Misuk Ji; Heungsup Sung; Tae Sun Shim; Woori Jang; Mi-Na Kim

doi:10.3343/lmo.2012.2.4.226

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Ji, Sung, Shim, Jang, and Kim: Mycoplasma pneumoniae Pneumonia Unresponsive to Macrolide Treatment

Case Discussion

Clinical Microbiology

Laboratory Medicine Online

Laboratory Medicine Online 2012; 2(4): 226-231.

Published online: 1 October 2012

DOI: https://doi.org/10.3343/lmo.2012.2.4.226

Mycoplasma pneumoniae Pneumonia Unresponsive to Macrolide Treatment

Misuk Ji, M.D.¹, Heungsup Sung, M.D.¹, Tae Sun Shim, M.D.², Woori Jang, M.D.³, Mi-Na Kim, M.D.¹

¹Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

²Department of Pulmonary and Critical Care Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.

³Department of Laboratory Medicine, The Catholic University of Korea School of Medicine, Seoul St. Mary's Hospital, Seoul, Korea.

Corresponding author: Mi-Na Kim, M.D. Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82-2-3010-4511, Fax: +82-2-478-0884, mnkim@amc.seoul.kr

Received 13 August 2012 Revised 15 August 2012 Accepted 16 August 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present a case of community-acquired pneumonia (CAP) that developed in a previously healthy young woman. She was diagnosed with Mycoplasma pneumoniae pneumonia, but did not respond to macrolide treatment. The pathogens of CAP was examined using chest radiographs, computed tomography, and various laboratory tests including Mycoplasma IgG and IgM antibodies, blood and sputum cultures, and PCR for M. pneumoniae, Legionella pneumophila, and Chlamydophila pneumoniae. In this study, differential diagnosis of the pathogens and analysis of the mechanisms underlying their resistance to macrolide treatment were performed, and the results were discussed. After changing the antimicrobial to quinolone, the patients' clinical symptoms and radiographic findings improved, and she was discharged after 8 days.

Keywords: Community-Acquired Pneumonia, Mycoplasma pneumoniae, Macrolide, Resistance

Figures and Tables

Fig. 1

Chronological changes observed in chest radiographs. (A) 2 days prior to admission at the local clinic, (B) day 1 of hospitalization, (C) day 3 of hospitalization, (D) 2 weeks after discharge.

Fig. 2

Antimicrobial therapy and clinical course.

Fig. 3

Electropherograms obtained with 23S rRNA gene sequencing of Mycoplasma pneumoniae isolated from sputum. A2063G mutation is shown by arrows.

Table 1

Laboratory results at the time of admission

^*Mycoplasma pneumoniae antibodies were tested with the CHORUS Mycoplasma IgG/IgM kit (DIESSE Diagnostica Senese, Siena, Italy).

Notes

This article is available from http://www.labmedonline.org

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