Atypical presentation of an atypical pneumonia: a case report
Abstract Background Neurologic impediments occur in only 0.1% of Mycoplasma pneumoniae infections. Although direct intracerebral infection can occur in these patients, autoimmune-mediated reactions secondary to molecular mimicry are the most common pathophysiology of such neurological complications....
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| Format: | Article |
| Language: | English |
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BMC
2022-03-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-022-03320-y |
| _version_ | 1818358384069443584 |
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| author | Alvin Oliver Payus Clarita Clarence Tiong Nee Wan Nur Nafisah Wan Yahya |
| author_facet | Alvin Oliver Payus Clarita Clarence Tiong Nee Wan Nur Nafisah Wan Yahya |
| author_sort | Alvin Oliver Payus |
| collection | DOAJ |
| description | Abstract Background Neurologic impediments occur in only 0.1% of Mycoplasma pneumoniae infections. Although direct intracerebral infection can occur in these patients, autoimmune-mediated reactions secondary to molecular mimicry are the most common pathophysiology of such neurological complications. These complications include immune-mediated encephalitis, peripheral neuritis such as Guillain–Barré syndrome, and many others. Miller Fisher syndrome is a one of the variants of Guillain–Barré syndrome that has been rarely linked to Mycoplasma pneumoniae infection. It is a condition classically characterized by the triad of ophthalmoplegia, areflexia, and ataxia. Most patients with Miller Fisher syndrome will have positive anti-ganglioside GQ1b antibodies found in their serum, making this autoantibody a very useful serological confirmation parameter. We report a case of a Miller Fisher syndrome in a woman with Mycoplasma pneumoniae infection. To the best of the authors’ knowledge, such cases have been only rarely described in literature. Case presentation A 35-year-old Chinese woman presented with sudden onset of double vision and ataxia 5 days after fever and mild flu symptoms. Her Mycoplasma pneumoniae antigen was positive with 1 over 2560 titer of total mycoplasma antibody and presence of immunoglobulin M antibody, suggesting acute infection, and her nerve conduction study revealed mild sensory axonal polyneuropathy with segmental demyelination. the Miller Fischer syndrome variant of Guillain-Barré syndrome secondary to Mycoplasma pneumonia was suspected and later confirmed by presence of serum anti-GQ1b autoantibody. She was treated with intravenous immunoglobulin 0.4 g/kg once daily for 5 days. Conclusions The objective of this report is to share a case of an uncommon neurological complication of Mycoplasma pneumoniae infection, to increase the level of suspicion among clinicians that Miller Fischer syndrome can occur as an atypical presentation of an atypical pneumonia. |
| first_indexed | 2024-12-13T20:28:08Z |
| format | Article |
| id | doaj.art-fc520e2dc3cb42f0b2283bd471d78495 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-13T20:28:08Z |
| publishDate | 2022-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-fc520e2dc3cb42f0b2283bd471d784952022-12-21T23:32:30ZengBMCJournal of Medical Case Reports1752-19472022-03-011611410.1186/s13256-022-03320-yAtypical presentation of an atypical pneumonia: a case reportAlvin Oliver Payus0Clarita Clarence1Tiong Nee2Wan Nur Nafisah Wan Yahya3Medicine Based Department, Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMSDepartment of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC)Hospital Rehabilitasi CherasDepartment of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC)Abstract Background Neurologic impediments occur in only 0.1% of Mycoplasma pneumoniae infections. Although direct intracerebral infection can occur in these patients, autoimmune-mediated reactions secondary to molecular mimicry are the most common pathophysiology of such neurological complications. These complications include immune-mediated encephalitis, peripheral neuritis such as Guillain–Barré syndrome, and many others. Miller Fisher syndrome is a one of the variants of Guillain–Barré syndrome that has been rarely linked to Mycoplasma pneumoniae infection. It is a condition classically characterized by the triad of ophthalmoplegia, areflexia, and ataxia. Most patients with Miller Fisher syndrome will have positive anti-ganglioside GQ1b antibodies found in their serum, making this autoantibody a very useful serological confirmation parameter. We report a case of a Miller Fisher syndrome in a woman with Mycoplasma pneumoniae infection. To the best of the authors’ knowledge, such cases have been only rarely described in literature. Case presentation A 35-year-old Chinese woman presented with sudden onset of double vision and ataxia 5 days after fever and mild flu symptoms. Her Mycoplasma pneumoniae antigen was positive with 1 over 2560 titer of total mycoplasma antibody and presence of immunoglobulin M antibody, suggesting acute infection, and her nerve conduction study revealed mild sensory axonal polyneuropathy with segmental demyelination. the Miller Fischer syndrome variant of Guillain-Barré syndrome secondary to Mycoplasma pneumonia was suspected and later confirmed by presence of serum anti-GQ1b autoantibody. She was treated with intravenous immunoglobulin 0.4 g/kg once daily for 5 days. Conclusions The objective of this report is to share a case of an uncommon neurological complication of Mycoplasma pneumoniae infection, to increase the level of suspicion among clinicians that Miller Fischer syndrome can occur as an atypical presentation of an atypical pneumonia.https://doi.org/10.1186/s13256-022-03320-yMiller Fisher syndromeMycoplasma pneumoniaeMolecular mimicryGQ1b gangliosideAntibodies |
| spellingShingle | Alvin Oliver Payus Clarita Clarence Tiong Nee Wan Nur Nafisah Wan Yahya Atypical presentation of an atypical pneumonia: a case report Journal of Medical Case Reports Miller Fisher syndrome Mycoplasma pneumoniae Molecular mimicry GQ1b ganglioside Antibodies |
| title | Atypical presentation of an atypical pneumonia: a case report |
| title_full | Atypical presentation of an atypical pneumonia: a case report |
| title_fullStr | Atypical presentation of an atypical pneumonia: a case report |
| title_full_unstemmed | Atypical presentation of an atypical pneumonia: a case report |
| title_short | Atypical presentation of an atypical pneumonia: a case report |
| title_sort | atypical presentation of an atypical pneumonia a case report |
| topic | Miller Fisher syndrome Mycoplasma pneumoniae Molecular mimicry GQ1b ganglioside Antibodies |
| url | https://doi.org/10.1186/s13256-022-03320-y |
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