Severe Mycoplasma Pneumonia: An Overlooked Driver of Secondary Organizing Pneumonia
Abstract
Abstract Introduction: Organizing pneumonia can be challenging to diagnose. Transbronchial biopsy samples are frequently too small for diagnosis and necessitate surgical biopsies. Mycoplasma is a common cause of community-acquired pneumonia that is associated with inflammatory sequelae. We demonstrate a new case in conjunction with a series of recent case reports that directly links organizing pneumonia as a consequence of mycoplasma pneumonia. Case Report: A 66-year-old man presented with cough, fever, and worsening shortness of breath for four weeks. He was initially treated as an outpatient for pneumonia with a course of cefuroxime, followed by a separate course of azithromycin and amoxicillin-clavulanate with no improvement in symptoms. After outpatient antibiotic failure, the patient was admitted for acute hypoxemic respiratory failure. On admission, intravenous vancomycin, piperacillin/tazobactam and azithromycin were started without improvement in clinical symptoms after five days. Due to recent international travel and lack of clinical improvement, the patient underwent bronchoscopy with bronchoalveolar lavage (BAL). PCR from the BAL was positive for mycoplasma pneumonia. Antibiotics were changed to doxycycline due to concern of macrolide resistance and piperacillin/tazobactam was changed to cefepime. After 5 days of doxycycline and 9 days of inpatient antibiotics without improvement coupled with repeat CT chest showing worsening dense bibasilar consolidations, there…
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