Clinical Characteristics, Treatment and Long-Term Prognosis of Mycoplasma pneumoniae-Associated Necrotizing Laryngotracheobronchitis in Children: A Report of Four Cases and Literature Review
Abstract
Background: Necrotizing laryngotracheobronchitis (NLTB) is a rare and life-threatening airway disease characterized by mucosal necrosis, ulceration and pseudomembrane formation. Mycoplasma pneumoniae-associated NLTB remains exceedingly rare in children, with merely sporadic cases reported globally.
Methods: Four previously healthy children hospitalized with M. pneumoniae-associated NLTB from January 2023 to June 2025 were enrolled retrospectively. We systematically analyzed clinical features, etiological findings, therapeutic regimens and follow-up outcomes of these cases, and reviewed relevant literature.
Results: The main clinical manifestations included fever, cough, hoarseness, tachypnea and dyspnea. Bronchoscopy confirmed the diagnosis of NLTB. Notably, most patients presented with disproportionately severe airway symptoms compared with radiological lesions. Combined etiological tests and targeted next-generation sequencing (tNGS) confirmed mixed infections in three cases. All children received macrolides or doxycycline plus glucocorticoids, and most underwent repeated bronchoscopic procedures. All achieved clinical remission and were discharged uneventfully. During follow-up, one patient developed tracheal granulation tissue hyperplasia, and the other developed bronchitis obliterans.
Conclusion: M. pneumoniae-associated NLTB should be strongly suspected in pediatric patients with M. pneumoniae infection who present with hoarseness, tachypnea, or dyspnea that cannot be…
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