A case of hemolytic anemia associated with interstitial lung disease, arthralgia and fever caused by Mycoplasma pneumoniae
Mycoplasma pneumoniae, Hemolytic Anemia, interstitial lung disease, agglutinin
Pulmonary interstitiopathies have become the most diagnosed forms of pneumonia in 2020 due to the COVID-19 pandemic. The spectrum of interstitiopathies is broad and includes idiopathic diseases and secondary forms. In April 2020, a 36-year-old man admitted to our department for arthralgias, fever, asthenia, cough, and dyspnea. In January 2020 fever, cough, arthralgias and asthenia appeared. In April, his general condition worsened with development of macrohematuria, malaise, and intense asthenia. On admission, the patient presented pale, asthenic and symptomatic for dyspnea and arthralgias. There was objective joint pain in the small joints of the hands, elbow, and knees with morning stiffness and decreased strength. CT of the chest documented ground-glass opacities in both lung fields. He performed 2 swabs for SARS-CoV2, which were negative. On hematochemical examination: IgM 332 mg/dL and ferritin 700.2 ng/ml. At venous blood smear peripheral venous blood, agglutination of erythrocytes. The serology (IgM) for M. Pneumoniae was positive with agglutinins in the serum; Doxaciclina was started. There was a progressive normalization of hemoglobin levels and cold agglutinins were gradually reduced and were no longer detected at 15 days after the start of treatment. At one month after discharge, pulmonary function had fully recovered and the picture of hemolytic anemia was resolved.
David Micarelli, Gianluca Santoboni, Michela Tarnani, Claudio Angrisani, Alessandra Fiorentini, Carlo Meschini