Abstract Introduction Mycoplasma pneumonia is one of the most common causes for atypical pneumonia, with a higher incidence in young and healthy patients. Most cases are mild and recovery is quick. Current standard of therapy is a short-course (5-7 days) of a macrolide, tetracycline, or fluoroquinolone antibiotic. However, certain vulnerable populations such as pregnant patients have immunologic alterations that are known to increase susceptibility to more severe respiratory infections. Even so, outcomes in severe Mycoplasma pneumoniae are rare and limited. We present a case of Mycoplasma pneumoniae in a pregnant patient on immunosuppressive therapy. Case An 18-year-old female at 16 weeks gestation with Crohn’s disease on adalimumab presented with several days of fever, pleuritic chest pain, dyspnea, cough, and sore throat. She was noted to be RSV-positive requiring 3L nasal cannula. Initial workup begun with bacterial and fungal cultures, tuberculosis testing, Legionella urinary antigen, HIV, and autoimmune testing which were negative. Chest CT revealed diffuse bilateral consolidative opacities (Fig 1). Pneumonia polymerase chain reaction panel was positive for Mycoplasma pneumoniae. Despite empiric ceftriaxone and azithromycin, her hypoxemia worsened leading to ICU admission and intubation. Bronchoalveolar lavage and transbronchial biopsies were negative. Despite a prolonged hospital course, she was discharged on day 17 with home oxygen. Discussion There is limited data regarding incidence and outcomes for severe Mycoplasma pneumoniae in pregnant and immunocompromised populations. Pregnant patients are at increased risk of respiratory failure in pneumonia because of expected physiologic and immunologic changes in pregnancy, such as increased oxygen consumption, reduced functional residual capacity, and decreased cell-mediated immunity. It has been noted that pregnant patients also have increased rates of ICU admission and longer lengths of stay from severe pneumonia, with additional risk of adverse pregnancy outcomes such as placental abruption or preterm birth. Despite these vulnerabilities, current ATS/IDSA guidelines for antibiotic regimens do not comment on extending or broadening antibiotic therapy in pregnant or immunocompromised individuals. Immunocompromised individuals make up 32% of severe CAP cases while only making up 3% of the US adult population and have increased mortality. Coinfection rates of Mycoplasma pneumoniae in immunocompromised patients are high, ranging from 10-27%, highlighting the need to do additional early microbiological testing. Coinfection resulted in an increased odds by 3.91 times of needing mechanical ventilation, 2.5 times length of stay, and a 2.05 times increase in mortality. This case ultimately highlights the need for better guidelines on antibiotics, mechanical ventilation, and broad infectious work-up. This abstract is funded by: None
Yin et al. (Fri,) studied this question.