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Weekly Chest CasesArchive of Old Cases

Case No : 556 Date 2008-06-23

  • Courtesy of Kwang Nam Jin, MD, Hyun Ju Lee, MD. / Seoul National University Hospital, Korea.
  • Age/Sex 19 / M
  • Chief ComplaintNeck pain, fever and chill (4DA), elevated AST(56 IU/L)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7
  • Figure 8

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Mycoplasma pneumonia combined with lymphadenopathy and hepatosplenic involvement
Radiologic Findings
Figs 1. Initial chest PA shows subtle increased opacity in the left lower lung zone.
Fig 2. Enlarged lymph nodes with central low attenuation in the left neck was found on the Neck CT scan.
Figs 3. Serial chest PA demonstrated progression of ground glass opacities in both lower lung zone.
Fig 4. Chest CT shows diffuse ground glass opacities and septal line thickening with bilateral pleural effusion. There is no enlarged lymph node in the mediastinum (not shown).
Fig 5. Hepatosplenomegaly and periportal low attenuation was noted on the CT scans.
Serologic examination revealed that antibody of Mycoplamsma was positive with 1:320. Other serologic markers including legionella, leptospirosis, R. tsutsugamuchi were negative. She underwent needle aspiration for the enlarged lymph node in the left neck. Cytologic examination revealed suppurative lymphadenitis with indeterminate etiology. After changing antibiotic regimen including Azithromycin, ground-glass opacities on the chest radiography had been resolved (Figure 6).
Brief Review
Mycoplasma pneumoniae is a common cause of community-acquired pnuemonia. It is seen most frequently in children and young adults but has been estimated to cause more than 15% of pneumonia in patients older than 40 years. The principal histologic abnormality is bronchiolitis, similar in appearance to that caused by viruses. Extension of infection and the concomitant inflammatory reaction into the parenchyma adjacent to the airways results in pneumonia [1].

The radiographic findings in mycoplasma pneumonia are nonspecific and in some cases closely resemble those seen in children with viral infections of the lower respiratory tract. Hazy or ground-glass consolidations frequently occur, but dense homogeneous consolidations like those seen with bacterial pneumonias are uncommon [2]. And it was reported that adult group showed diffuse and/or multifocal, centrilobular or peribronchovascular areas of ground-glass attenuation with a lobular distribution and frequent thickening of the bronchial walls and interlobular septa were demonstrated in adult group[3].

Although manifestations of mycoplasma infection are usually confined to the respiratory tract, a wide variety of extrarespiratory manifestations can also occur, including more severe associated diseases such as myocarditis, acute disseminated encephalomyelitis, and cerebral arteriovenous occlusion [2]. Lymphadenitis or hepatitis was also known as the extrapulmonary manifestation of mycoplama pneumoniae infection [4-7].
References
1. Diseases of the lung: Radiologic and pathologic correlation, Philadelphia: lipincott Williams & Wilkins, 2003:68-69
2. Susan D. John, Janaki Ramanathan, Leonard E. Swischuk. Spectrum of Clinical and Radiographic Findings in Pediatric Mycoplasma Pneumonia, RadioGraphics 2001; 21:121?31
3. Inho Lee, Tae Sung Kim, Hye-Kyung Yoon. Mycoplasma pneumoniae pneumonia:CT features in 16 patients. Eur Radiol, 2006; 16:719?25
4. Narita M, Yamada S, Nakayama T, et al. Two cases of lymphadenopathy with liver dysfunction due to Mycoplasma pneumoniae infection with mycoplasmal bacteraemia without pneumonia.J Infect. 2001 Feb;42(2):154-6.
5. Squadrini F, Lami G, Pellegrino F, et al. Acute hepatitis complicating Mycoplasma pneumoniae infection.
6. Cunha BA. J Clin Microbiol. 2003 Jul;41(7):3456 Liver involvement with Mycoplasma pneumoniae community-acquired pneumonia.
7. Mukai S, Mukai C, Asaoka K, et al. Mycoplasma-induced upper deep-cervical lymphadenitis. Ear Nose Throat J. 1987 Apr;66(4):159-62.
Keywords
Lung, Multiple organ, Infection, Bacterial infection,

No. of Applicants : 63

▶ Correct Answer : 1/63,  1.6%
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
▶ Correct Answer as Differential Diagnosis : 7/63,  11.1%
  • - China Medical University,Taiwan,R.O.C. , Taiwan Jun JunYeh
  • - mediciti hospitals , India paramjyothi gongati
  • - Mackay Memorial Hospital , Taiwan Shen ShengYeh
  • - McGill University Health Centre , Canada Amr Ajlan
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
▶ Semi-Correct Answer : 44/63,  69.8%
  • - Kashan University of Medical Sciences, kashan, Iran , Iran Ebrahim Razi
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Osaka University , Japan Osamu Honda
  • - hospital Sao Paulo , Brazil israel missrie
  • - OSWAL CANCER HOSPITAL , India LOVKESH MITTAL
  • - CHRU lille , France manuel toledano
  • - Marien Hospital, Hamm , Germany Davis Chiramel
  • - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
  • - Saga University, Japan , Japan Ryoko Egashira
  • - Soon chun hyang university hospital bucheon , Korea (South) Hyelin Kim
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - apollo hospitals , India harish bhambore
  • - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - Cheongshim international medical center , Korea (South) Yang Hae Jum
  • - BOLLINENI HOSPITAL NELLORE , India jignesh dubal
  • - brm hospital , India chemmandi sudhan
  • - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
  • - Hanyang university , Korea (South) Ji Young Kim
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - partner, aditya imaging centre , India vivek patel
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Good Gangan Hospital , Korea (South) Kyung Hwa Jung
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - kims,narkatpally , India k bhaskar
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Hanmaeum Hospital , Korea (South) Kwon Kim
  • - Yonsei University college of medicine Severance hospital , Korea (South) Hua Sun Kim
  • - radiology department ANNECY , France gilles GENIN
  • - Dongguk University International Hospital , Korea (South) Hee Seok Choi
  • - Samsung Medical Center , Korea (South) Dae Kun Oh
  • - chp st martin , France Mariotte benoit
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Depatment of Radiology, Yongsan Hospital, College of Medicine, Chung-Ang University , Korea (South) Jae Seung Seo
  • - Pe d , France Fabrice Bing
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - CH de la Ce Basque , France Paul ARDILOUZE
  • - All India Institute of medical sciences , India Justin Moses
  • - Jackson Memorial Hospital , United States Naganathan Mani
  • - Hopital universitaire Lausanne , Switzerland abed kourhani
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