■肺炎支原体可能与肺外表现有关,包括血管炎,心肌炎,和血栓形成。在极少数情况下,它也与心内血栓形成有关。
■一名健康的25岁男性表现为腹痛恶化,急性胸痛发作,新的头晕,肺炎支原体的步态不稳定。最初的血液检查值得注意的是轻度凝血病,血小板增多症,转胺炎,高敏肌钙蛋白升高.Further,检查显示小脑有系统性栓塞,肾脏,脾,脾前壁心肌梗死,和左心室多叶壁块。由于肿块的成分未知,担心进一步的栓塞事件,患者接受了成功的手术切除,肿块最终被定义为血栓.高凝状态检查明显不确定,术中心肌活检显示组织梗死,无炎症或心肌炎愈合。术后病程并发左心功能不全和急性肾损伤,两者都有最终的改善。患者仍接受指南指导的药物治疗和预防性抗凝治疗。
■我们认为,在这种情况下,心室血栓的形成是肺炎支原体短暂的血栓形成导致冠状动脉阻塞和随后的心肌损伤的结果。该病例强调了确定发生全身性栓塞的支原体患者的病理生理事件顺序以及对大量残余血栓的管理的挑战。特别是关于外科手术的考虑。
UNASSIGNED: Mycoplasma pneumoniae can be associated with extrapulmonary manifestations, including vasculitis, myocarditis, and thrombosis. In rare cases, it has also been implicated in intracardiac
thrombus formation.
UNASSIGNED: A previously healthy 25-year-old male presented with worsening abdominal pain, an episode of acute chest pain, new lightheadedness, and gait instability in the setting of M. pneumoniae. Initial blood tests were notable for mild coagulopathy, thrombocytosis, transaminitis, and elevated high-sensitivity troponin. Further, workup revealed systematic emboli to the cerebellum, kidneys, spleen, anterior myocardial infarction, and a left ventricular multilobular mural mass. Due to the unknown composition of the mass with concern for further embolic events, the patient underwent successful surgical excision with the mass ultimately defined as a
thrombus. Hypercoagulable workup was notably inconclusive and intraoperative myocardial biopsies revealed organizing infarction without inflammation or healed myocarditis. Post-operative course was complicated by left ventricular dysfunction and acute kidney injury, both with eventual improvement. Patient has remained on guideline-directed medical therapy and prophylactic anticoagulation.
UNASSIGNED: We presume that the formation of the ventricular
thrombus in this case was a result of transient thrombophilia in the setting of M. pneumonia resulting in coronary obstruction and subsequent myocardial injury. This case underscores the challenge of determining the pathophysiological sequence of events in patients with mycoplasma who develop systemic embolism and the management of a large residual
thrombus, particularly in regard to surgical consideration.