Atypical Pneumonia with Severe Extrapulmonary Manifestations: Mycoplasma pneumoniae-associated Hemolysis and Nephritis

Mycoplasma pneumoniae is a common cause of atypical pneumonia, with extrapulmonary manifestations occurring in approximately 25% of cases. We report a case of a 34-year-old male presenting with fever, hemoptysis, hematuria, and progressive respiratory distress. Initial investigations revealed anemia, hemolysis, and proteinuria. Sputum analysis detected M. pneumoniae , alongside Streptococcus pneumoniae and Haemophilus influenzae . Autoimmune hemolytic anemia (AIHA) was confirmed with a positive direct Coombs test, elevated cold agglutinin titer, and peripheral smear findings. Renal involvement manifested as hematuria and proteinuria. The patient was treated with oxygen support, intravenous antibiotics, and corticosteroids, leading to clinical improvement. This case highlights the potential for severe extrapulmonary complications of M. pneumoniae , including AIHA and nephritis. Early recognition and appropriate management are essential to prevent adverse outcomes.