肺炎支原体是一种自身繁殖的微生物,通常会引起呼吸道感染。它还可以引起多种肺外症状,伴有或独立于呼吸道症状,如皮肤损伤,关节痛,肌痛,溶血,心脏损伤,胃肠道症状,中枢神经系统损伤,这是罕见的表现,在大约0.1%的病例中报告。在这项研究中,我们介绍了一个独特的支原体相关的外展神经麻痹,多发性关节炎,和多形性红斑无呼吸道疾病。病人是一名69岁的妇女,她出现皮疹到我们医院就诊,发烧,关节痛,和复视无呼吸道症状。脑磁共振成像显示右侧视神经炎,提示复视是由右外展神经麻痹引起的。然而,外展神经麻痹的病因没有通过体检发现,血液生化测试,或细菌学检查,包括入院时的脑脊液检查。怀疑支原体感染是由皮肤活检和多发性关节痛发现的多形性红斑引起的,最终根据配对血清中支原体颗粒凝集(PA)抗体升高进行诊断。虽然米诺环素并没有改善她的复视,每天服用30毫克泼尼松龙逐渐改善了她的症状,和支原体PA抗体滴度,在临床过程中定期测量,也减少了,提示支原体感染与外展神经麻痹之间的关系。这是第一例孤立的外展神经麻痹,据报道,这是成人支原体感染患者唯一的中枢神经症状。肺炎支原体引起中枢神经系统表现的机制或发病机制尚待阐明。需要进一步调查。因此,支原体感染是一种常见病。临床医生应该意识到不同的表现,包括外展神经麻痹,即使没有典型的呼吸道症状,也应考虑支原体感染。
Mycoplasma pneumoniae is a self-propagating microorganism that commonly causes respiratory tract infections. It can also cause a variety of extrapulmonary symptoms with or independently of respiratory symptoms, such as skin lesions, arthralgia, myalgia, hemolysis, cardiac lesions, gastrointestinal symptoms, and central nervous system lesions, which are rare manifestations reported in approximately 0.1% of cases. In this study, we present a unique case of Mycoplasma-related abducens nerve palsy, polyarthritis, and erythema multiforme without respiratory disease. The patient was a 69-year-old woman who presented to our hospital with a skin rash, fever, arthralgia, and diplopia without respiratory symptoms. Brain magnetic resonance imaging showed optic neuritis on the right side, suggesting the diplopia was caused by right abducens nerve palsy. However, the etiologies of abducens nerve palsy were not revealed by the physical examination, blood biochemistry tests, or bacteriological examinations, including the cerebrospinal fluid examination obtained at admission. Mycoplasma infection was suspected from erythema multiforme revealed by a skin biopsy and polyarthralgia, and it was finally diagnosed according to elevated Mycoplasma particle agglutination (PA) antibodies in paired serum. Though minocycline did not improve her diplopia, the daily administration of 30 mg of prednisolone gradually improved her symptoms, and the Mycoplasma PA antibody titer, which was regularly measured in the clinical course, also decreased, suggesting a relationship between Mycoplasma infection and abducens nerve palsy. This is the first case of isolated abducens nerve palsy, which was reported as the only central neurological symptom in an adult patient with Mycoplasma infection. The mechanism or pathogenesis of CNS manifestations caused by Mycoplasma pneumoniae remains to be elucidated, and further investigation is needed. Hence, Mycoplasma infection is a common disease. Clinicians should be aware of the diverse manifestations, including abducens nerve palsy, of Mycoplasma infection and should consider Mycoplasma infection even in the absence of typical respiratory symptoms.