Neurological Complications of Mycoplasma pneumoniae: Three Paediatric Cases
DOI:
https://doi.org/10.46531/sinapse/CC/218/2026Keywords:
Child, Encephalomyelitis, Acute Disseminated, Mycoplasma pneumoniae, Myelin-Oligodendrocyte Glycoprotein, Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease, Optic Neuritis, Pneumonia, Mycoplasma/complicationsAbstract
Mycoplasma pneumoniae is mainly responsible for respiratory diseases but neurological complications may occur through direct invasion or post-infectious immune response, as observed in three paediatric patients during the 2023/24 outbreak.
A 3-year-old boy presented with respiratory symptoms, ataxia, nystagmus, action tremor and somnolence. Cerebrospinal fluid (CSF) findings and positive serology suggested M. pneumoniae-associated encephalitis, treated with azithromycin.
The second case was a 13-year-old boy with MOG antibody-associated optic neuritis, six weeks after a respiratory infection, suggesting an immune-mediated process triggered by M. pneumoniae (positive serology). Antibiotics and corticosteroids led to recovery.
The third case involved a 14-year-old boy with reduced consciousness, headache, ataxia, and vomiting, one week after respiratory symptoms. Magnetic resonance imaging and CSF findings suggested acute disseminated encephalomyelitis, following M. pneumoniae infection (positive serology and PCR). Clinical improvement was observed after corticosteroids and intravenous immunoglobulin.
These cases highlight the importance of early recognition and prompt treatment of M. pneumoniae-related neurological complications.
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References
Sauter PM, Beeton ML; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC), and the ESGMAC Mycoplasma pneumoniae Surveillance (MAPS) study group. Mycoplasma pneumoniae: delayed re-emergence after COVID-19 pandemic restrictions. Lancet Microbe. 2024;5:e100-1. doi:10.1016/S2666-5247(23)00344-0
Taborda I, Tomé R, Santos Ferreira C, Oliveira Inácio R, Vaz J, Carmo A, et al. No Increase in Severity of Mycoplasma pneumoniae: Insights From the Postpandemic Epidemic. Pediatr Infect Dis J. 2025;44:e24-6. doi: 10.1097/INF.000000000004545.
D'Alonzo R, Mencaroni E, Di Genova L, Laino D, Principi N, Esposito S. Pathogenesis and Treatment of Neurologic Diseases Associated with Mycoplasma pneumoniae Infection. Front Microbiol. 2018;9:2751. doi: 10.3389/fmicb.2018.02751.
Al-Zaidy SA, MacGregor D, Mahant S, Richardson SE, Bitnun A. Neurological Complications of PCR-Proven M. pneumoniae Infections in Children: Prodromal Illness Duration May Reflect Pathogenetic Mechanism. Clin Infect Dis. 2015;61:1092-8. doi: 10.1093/cid/civ473.
Laila A, El-Labadibi RM, Hisham M, Mooty M. A case of acute disseminated encephalomyelitis following Mycoplasma pneumoniae infection. IDCases. 2018;12:41-43. doi: 10.1016/j.idcr.2018.03.003.
Yimenicojuu S, Yakut A, Ekici A, Bora Carman K, Cagri Dinleyici E. Mycoplasma pneumoniae infection with neurologic complications. Iran J Pediatr. 2014;24:647-51.
Huang X, Guo R, Li C, Long X, Yang T, Hou X, et al. A case of anti-emyelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) associated disorder (MOGAD) with clinical manifestations of acute disseminated encephalomyelitis: Secondary to mycoplasma pneumoniae infection. Heliyon. 2023;9:e13470. doi: 10.1016/j.heliyon.2023.e13470.
Liu YR, Zeng XD, Xiong Y. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated encephalitis induced by Mycoplasma pneumoniae infections. Ital J Pediatr. 2024;50:195. doi: 10.1186/s13052-024-01768-w.
Zeng XD, Chen H, Hu WG. Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated meningoencephalitis due to Mycoplasma pneumoniae infection. Neurol Res. 2023;45:124-6. doi: 10.1080/01616412.2022.2124794.
Jaruratanasirikul S, Hortiwakul R, Tantisarasart T, Phuenpathom N, Tussanasunthornwong S. Distribution of azithromycin into brain tissue, cerebrospinal fluid, and aqueous humor of the eye. Antimicrob Agents Chemother. 1996;40:825-6. doi: 10.1128/AAC.40.3.825.
Kim K, Jung S, Kim M, Park S, Yang HJ, Lee E. Global trends in the proportion of macrolide-resistant Mycoplasma pneumoniae infections: a systematic review and meta-analysis. JAMA Netw Open. 2022;5:e2220949. doi: 10.1001/jamaneetworkopen.2022.20949.
Kumta N, Roberts JA, Lipman J, Wong WT, Joynt GM, Cotta MO. A systematic review of studies reporting antibiotic pharmacokinetic data in the cerebrospinal fluid of critically ill patients with uninflamed meninges. Antimicrob Agents Chemother. 2020;65:e01998-20. doi: 10.1128/AAC.01998-20.
Fan G, Guo Y, Tang F, Chen M, Liao S, Wang J. Determining the Clinical Characteristics, Treatment Strategies, and Prognostic Factors for Mycoplasma pneumoniae Encephalitis in Children: A Multicenter Study in China. J Clin Neurol. 2023;19:402-9. doi: 10.3988/j.cn.2022.0328.
Daba M, Kang PB, Sladky J, Bidari SS, Lawrence RM, Ghosh S. Intravenous Immunoglobulin as a Therapeutic Option for Mycoplasma pneumoniae Encephalitis. J Child Neurol. 2019;34:687-91. doi: 10.1177/0883073819854854.
Choi SY, Choi YJ, Choi JH, Choi KD. Isolated optic neuritis associated with Mycoplasma pneumoniae infection: report of two cases and literature review. Neurol Sci. 2017;38:1323-7. doi: 10.1007/s10072-017-2922-9.
Hacohen Y, Banwell B. Treatment approaches for MOG-Ab-associated demyelination in children. Curr Treat Options Neurol. 2019;21:2. doi: 10.1007/s11940-019-0541-x.
Jeyakumar N, Lerch M, Dale RC, Ramanathan S. MOG antibody-associated optic neuritis. Eye. 2024;38:2289-301. doi: 10.1038/s41433-024-03108-y.
Hacohen Y, Wong YY, Lechner C, Jurynczyk M, Wright S, Konuskan B, et al. Disease course and treatment responses in children with relapsing myelin oligodendrocyte glycoprotein antibody-associated disease. JAMA Neurol. 2018;75:478-87. doi: 10.1001/jamaneurol.2017.4601.
Feil K, Ruf B, Behling F, Kozak G, Gohla G, Riessen R, et al. Case Report: severe Mycoplasma pneumoniae-associated acute disseminated encephalomyelitis in an adult: challenges in diagnosis and management. Front Med. 2025;12:1627241. doi: 10.3389/fmed.2025.1627241.
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Copyright (c) 2026 Vitória Cadete, Beatriz Cordeiro Martins, Rui Duarte Armindo, Raquel Ferreira, Clara Marecos
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