M pneumoniae infection, pulmonary thromboembolism and antiphospholipid antibodies.
A 28-year-old, hypertensive and hypercholesterolaemic patient, was referred to our emergency unit with a mild thoracic pain, productive cough and a body temperature of 37.3°C. Laboratory examinations showed normal white cell count and moderate elevation of C reactive protein (CRP). Later, the thoracic pain increased accompanied by shortness of breath. High D-dimer was detected. Positive lupic anticoagulant factor and anticardiolipin and antibodies anti-Mycoplasma pneumoniae were present and high titres of antinuclear factor. Recombinant tissue-type plasminogen activator plus heparin and vancomycin were administered due the high possibility of mycoplasma pneumonia associated with pulmonary thromboembolism. CRP increased to very high levels with very mild modification of white blood cells during the evolution. Thoracic tomography and pulmonary scintigraphy of the lungs confirmed the diagnosis. The patient responded well and he was discharged after 25 days medicated with hydroxychloroquine sulphate, warfarin and aspirin. At present date he is well (150 days).
Department of Immunology, University of Sao Paulo, Sao Paulo, Brazil. Elia.ascer@incor.usp.br
Elia
E
Ascer
Marcus
M
Marques
Magnus
M
Gidlund
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017152:Antibodies, Antiphospholipid / Q000097:blood; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000175:diagnosis; D002097:C-Reactive Protein / Q000032:analysis; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital; D006801:Humans; D008297:Male; D009177:Mycoplasma pneumoniae; D011019:Pneumonia, Mycoplasma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011655:Pulmonary Embolism / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D014640:Vancomycin / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D017152:Antibodies, Antiphospholipid; D000925:Anticoagulants; D014640:Vancomycin; D002097:C-Reactive Protein