Mycoplasma pneumoniae-associated cerebral infarction in a child: A case report and literature review

Rationale: Mycoplasma pneumoniae (MP) is a common pathogen causing respiratory infections in children, with clinical manifestations ranging from mild infection to severe necrotizing pneumonia. Although increasing evidence links MP to cerebral infarction, its underlying mechanisms remain poorly understood due to limited data. This report describes a rare case of pediatric cerebral infarction secondary to MP infection, successfully treated with levofloxacin, methylprednisolone, and anticoagulation therapy, with a favorable outcome at 9-month follow-up. Patient concerns: A 6-year-old girl was initially hospitalized after experiencing a 5-day history of fever, reaching a peak of 40.3 °C, along with a cough. Diagnoses: Following an ineffective course of cefoperazone/sulbactam and azithromycin, the patient developed drowsiness, persistent headaches, and motor deficits. Magnetic resonance angiography identified acute cerebral infarction affecting the right frontal, parietal, and occipital lobes. The patient was subsequently diagnosed with severe Mycoplasma pneumonia and right middle cerebral artery stenosis and occlusion. Further evaluation revealed signs of systemic hypercoagulability, characterized by elevated D-dimer levels, positive IgM anticardiolipin antibodies, and heightened inflammatory markers such as C-reactive protein, interleukin-6, and interleukin-10. These findings corroborated the diagnosis of cerebral infarction, with MP infection identified as the underlying etiological factor. Interventions: Due to persistent fever, the antibiotic regimen was revised. The patient was initiated on levofloxacin, complemented by anticoagulation therapy and methylprednisolone, which collectively resulted in a gradual and sustained clinical improvement. Outcomes: Neurological function improved over weeks of treatment. However, subsequent follow-up at another medical facility revealed a diagnosis of Moyamoya disease, prompting surgical intervention. The child recovered substantially and is currently in a stable condition. Lessons: MP infection can cause severe complications such as vasculitis and hypercoagulability, increasing the risk of cerebral infarction in children. Timely diagnosis, close monitoring of inflammatory markers, D-dimer levels, and neurological assessment are essential. In cases unresponsive to macrolides, consideration of quinolones or tetracyclines may be warranted, with attention to potential side effects. Underlying vascular anomalies, such as Moyamoya disease, should also be considered in pediatric stroke cases.