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Australasian Medical Journal [AMJ 2013, 6, 2, 73-74] Unusual complication of Mycoplasma pneumonia in a five-year-old child Pratap Kumar Patra and Thirunavukkarasu Arun Babu Department of Pediatrics, Indira Gandhi Medical College and Research Institute (IGMC&RI), Pondicherry, India CASE REPORT Please cite this paper as: Patra PK, Arun Babu T. Unusual complication of Mycoplasma pneumonia in a five-year-old child. AMJ 2013, 6, 2, 73-74. http//dx.doi.org/10.4066/AMJ.2013.1543 Corresponding Author: Thirunavukkarasu Arun Babu Department of Pediatrics, Indira Gandhi Medical College & Research Institute (IGMC&RI), Pondicherry, India Email: babuarun@yahoo.com Abstract Mycoplasma pneumoniae is common agent causing community acquired pneumonia in children. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a five-year-old child with massive pleural effusion and empyema secondary to Mycoplasma pneumonia infection. This potential yet rare source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed. Key Words Mycoplasma pneumoniae, Pleural Effusion, Empyema Implications for Practice Mycoplasma pneumonia causes primary atypical pneumonia in older children. Mycoplasma pneumonia usually runs an uncomplicated course in most patients. Massive pleural effusion and empyema can complicate Mycoplasma infection in children. Mycoplasma should be considered in differential diagnosis while encountering syn-pneumonic effusions and empyema. Background Mycoplasma pneumoniae (Mp) is a significant cause of pneumonia in children above five years of age. It commonly 1 causes tracheobronchitis and bronchopneumonia. The pulmonary complications of mycoplasma infection include severe and rapidly progressive pneumonia in the immunocompromised followed by acute respiratory distress 2,3 syndrome, however empyema is extremely rare. We report a rare case of empyema secondary to Mycoplasma pneumoniae infection in a five-year-old child. Case details This child presented with complaints of cough, congestion and fever over the preceding seven days. On examination ° the child had a fever of 39.3 C with a congested throat but no evidence of rhinitis or lower respiratory involvement was present. The child was started on oral amoxicillin for acute pharyngitis and discharged. However, the child was brought to the hospital again after two days due to increasing fever and cough. Respiratory system examination revealed reduced air entry on right side but with no other adventitious sounds. Chest X-ray revealed opacification over the right mid zone area. His initial investigations revealed Haemoglobin - 11.3gm%, Total Leucocyte Count - 6450 cells/cu mm, Differential Count - N 72, L 18, M 03, E 07 and significantly elevated C - reactive protein (70mg/dl). He was hospitalised and given intravenous cefotaxime and clarithromycin. There was no clinical improvement after three days of therapy and the child continued to remain febrile. His blood culture did not reveal any growth. IgM antibodies for Mp by enzyme linked immunoassay (EIA) were positive with titres of 1: 5120. Liver function test on day four of admission revealed SGPT 265 U/L, SGOT 226 U/L, and total serum bilirubin 0.22mg/dl for which clarithromycin was withdrawn from the antibiotic regimen and oral doxycycline was added. Liver function tests improved following the withdrawal of clarithromycin. Repeat chest X-ray revealed extension of consolidation up to right mid zone and right lower zone with ipsilateral massive pleural effusion (Figure 1). A CT scan of the chest revealed consolidation of the right mid and lower zone along with pleural effusion for which thoracocentasis was