Successful management of severe cerebral infarctions in a child with macrolide-resistant <i>Mycoplasma pneumoniae</i>: A case report

Mycoplasma pneumoniae infection can rarely cause cerebral infarctions in children through various pathophysiological mechanisms, including hypercoagulable state.The increasing prevalence of Macrolide-resistant Mycoplasma pneumoniae (MRMP) is concerning, as these resistant strains are associated with more severe clinical presentations and higher risk of extrapulmonary complications.We report a case of severe cerebral infarction in a 6-year-old boy with confirmed MRMP pneumonia.Despite appropriate macrolide therapy, the patient developed acute right-sided hemiparesis during the course of treatment.Brain magnetic resonance imaging revealed the left middle cerebral artery occlusion and cerebral infarction.Laboratory findings demonstrated elevated D-dimer and positive antiphospholipid antibodies, suggesting hypercoagulable state.The patient underwent mechanical thrombectomy with partial recanalization, followed by combination therapy including alternative antibiotics, corticosteroids, and anticoagulation.During the follow-up, the patient showed marked neurological improvement with minimal residual deficits.This case highlights the potential for severe cerebrovascular complications in MRMP infection and demonstrates the effectiveness of prompt intervention with appropriate antimicrobial and antithrombotic therapy in pediatric patients.