김신태, 이선녕, 이석정, 정필문, 박홍준, 신명상, 김종환, 이부길, 김상하, 리원연, 신계철, 용석중 Shin-Tae Kim, M.D., Shun Nyung Lee, M.D., Seok Jeong Lee, M.D., Pil Moon Jung, M.D., Hong Jun Park, M.D., Myung Sang Shin, M.D., Chong Whan Kim, M.D., Bu Ghil Lee, M.D., Sang-Ha Kim, M.D., Won-Yeon Lee, M.D., Kye Chul Shin, M.D., Suk Joong Yong, M.D. Mycoplasma pneumoniae (M. pneumoniae) is the leading cause of pneumonia in older children and young adults. Normally, it does not progress to a condition requiring hospitalization but improves spontaneously or has a mild clinical course. We report two cases of M. pneumoniae pneumonia with different clinical manifestations from the normal course. The patients were young healthy individuals. The diagnoses were made by serology. However, it could not be determined beforehand that they had M. pneumoniae pneumonia. Based on the empirical treatment strategy of severe community acquired pneumonia, the patients were treated with broad-spectrum antibiotics including cephalosporin, quinolone and macrolide. After administering the antibiotics, they showed a gradually favorable clinical course and recovered without residual complications. A M. pneumoniae infection should be considered as a cause of severe community acquired pneumonia, and empirical treatment targeting this organism might be helpful in treating patients with the severe manifestation. (Tuberc Respir Dis 2007;63:515-520) Mycoplasma pneumoniae, Severe pneumonia, Quinolone, Macrolide 서 론 증례증례 1 515
ST Kim et al: Mycoplasma pneumoniae infection with severe pneumonia > Figure 1. A 29-year-old woman with M. pneumoniae pneumonia. Chest radiograph at admission reveals bilateral, patch and lobar consolidation in right upper and left lower lung field (A). Chest CT scan, 2 days later, shows muti-focal consolidation (B). Follow up chest radiograph, 3days later, shows more extensive bilateral consolidation (C). Follow up chest radiograph, 9 days later, shows nearly complete resolution (D). 516
Tuberculosis and Respiratory Diseases Vol. 63. No. 6, Dec. 2007 > : : 증례 2 Figure 2. A 29-year-old man with M. pneumoniae pneumonia. Chest radiograph at admission reveals bilateral, patch and lobar consolidation in right lower and left upper lung field (A). Chest CT scan shows muti-focal lobar consolidation, mainly in right lower lobe, with pleural effusion (B). Fiberoptic bronchoscopy shows ulcerative lesion covered with necrotic exudation on the posterior wall of trachea (C). Follow up chest radiograph, 3days later, shows more aggravated consolidation (D). Follow up chest radiograph, 13 days later, shows improved state (E). 517
ST Kim et al: Mycoplasma pneumoniae infection with severe pneumonia 고찰 : : : : : : : : 518
Table 1. Cases of M. pneumoniae pneumonia with severe manifestation in Korea Tuberculosis and Respiratory Diseases Vol. 63. No. 6, Dec. 2007 Age/Sex Clinical manifestation Cold agglutinin titer M. pneumoniae Ab Treatment Reference 27/F 43/F 25/M 19/F 68/M ARDS, pleural effusion, Raynaud's phenomenon ARDS ARDS, seizure, hemolytic anemia Extensive bilateral airspace consolidation, pneumonia, pleural effusion ARDS, erythematous skin lesion 1:512? 1:1,024 1:40 1:640 1:10,240 Positive* 1:20,480 1:160 1:64 Cephalosporin, Aminoglycoside Erythromycin added Treated by erythromycin after extubation Cephalosporin, Aminoglycoside Erythromycin added Empirical antibiotics(?)+ Methylprednisolone Cefamandole, Roxithromycin Cefotaxime, Tobramycin, Roxithromycin+Prednisolone 8 9 10 11 12 *titer not described, negative in initial finding. ARDS=Acute respiratory distresssyndrome. 519
ST Kim et al: Mycoplasma pneumoniae infection with severe pneumonia 요 약 참고문헌 520