Acute hepatitis secondary to Mycoplasma pneumoniae infection

Background:In the etiological study of hypertransaminasemia in pediatrics, we may diagnose conditions rarely related to hepatitis.After completing the differential diagnosis, if we do not find another possible etiology, we must assume the diagnosis of unusual entities.The incidence of hepatitis in Mycoplasma pneumoniae infections is about 7%, with transaminase levels higher than 500 IU/l being uncommon.Clinical case: A 5-year-old patient with hypertransaminasemia (ALT 723 IU/l, AST 426 IU/l) in the context of pallor, asthenia, and epigastralgia.Complementary tests showed positive serology for M. pneumoniae with autoimmune and abdominal ultrasound without abnormalities.Acute hepatitis caused by Mycoplasma was the diagnosis.A course of oral azithromycin was received with disappearance of symptoms in the first days, and transaminase levels had a gradual decrease in the following months.Conclusions: Due to the prominent burden of autoimmune diseases in the family history, autoimmune hepatitis should be excluded.Hepatic involvement by M. pneumoniae is rare, being caused by an immune-mediated phenomenon.Transaminase values as high as those obtained in this patient were exceptional.