Clinical Pediatrics: Open Access
Open Access

Abstract

Neurological Manifestations of Mycoplasma pneumoniae in Children: A Series of Eight Cases

Tuqa Abdulsalam, Lemis Yavuz, Mouhamad Al Dirawi, Shazia Chicken, Moza Alhammadi and Walid AbuHammour*

Background: Mycoplasma pneumoniae is a known factor for respiratory illnesses in children. However, extrapulmonary impact is being increasingly identified. Encephalitis, cerebellitis and rare immune-mediated syndromes caused by mycoplasma have been increasingly identified. Normal systemic inflammatory markers and nonspecific Cerebrospinal Fluid (CSF) findings often hinder diagnosis.

Methods: We reported eight cases of patients who presented with neurologic manifestations associated with Mycoplasma pneumoniae from 2023 to 2024 at a tertiary pediatric hospital. The diagnosis was established through clinical presentation, analysis of cerebrospinal fluid, neuroimaging findings, respiratory polymerase chain reaction PCR and serological assays. We evaluated management strategies, clinical pathways and outcomes.

Results: We identified eight pediatric cases (five males and three females; mean age 10 years, range 4-13 years) cases of Central Nervous System (CNS) involvement in association with Mycoplasma pneumoniae infection. Two children had encephalitis and no focal features. Another two were diagnosed with encephalitis with focal limbic presentation accompanied by neuropsychiatric signs. Acute cerebellitis was identified in two children. One child showed involvement of an Acute Disseminated Encephalomyelitis ADEM-like demyelinating syndrome and simultaneous optic neuritis and was additionally associated with pituitary hyperplasia and secondary adrenal insufficiency. The last case was a case of isolated meningitis.

CSF analysis revealed lymphocytic pleocytosis in seven children, accompanied by normal or mildly elevated inflammatory markers. All patients tested positive for Mycoplasma pneumoniae serology IgM and the respiratory PCR was positive in one child. Neuroimaging studies demonstrated a wide range starting from normal findings to cerebellar hyperintensities, demyelinating white matter lesions, optic nerve enhancement and pituitary hypertrophy. All patients were initially treated with empirical antimicrobials consisting of levofloxacin. Five children were treated with immunomodulatory therapy, including corticosteroids, Intravenous Immunoglobulin IVIG or a combination of both.

Complete (or near-complete) neurologic recovery was attained in seven children. One child had a visual impairment that persisted. These cases illustrate the neurological manifestations of Mycoplasma pneumoniae in pediatric patients, highlighting the importance of early identification and multidisciplinary care to achieve a favorable outcome.

Conclusion: Symptoms related to Mycoplasma pneumoniae infection are not confined to the respiratory system. Neurological conditions associated with this pathogen can present a wide range of symptoms, including rare occurrences such as pituitary dysfunction and optic neuritis. Early diagnosis and the initiation of appropriate therapy can significantly improve outcomes.

Published Date: 2026-01-29; Received Date: 2025-12-29