A Rare Case of Fulminant Mycoplasma pneumoniae Pneumonia With ARDS

Fulminant pneumonia due to Mycoplasma pneumoniae (MP) is rare, despite the high prevalence of Mycoplasma infections in the general population. We report a case of atypical pneumonia complicated by Acute Respiratory Distress Syndrome (ARDS) in a young female, highlighting the clinical challenges encountered and summarizing relevant literature.

Mycoplasma pneumoniae, historically known as the “Eaton agent,” is a common respiratory pathogen and the leading cause of atypical pneumonia, accounting for nearly 20–40% of community-acquired pneumonia (CAP) cases [1]. Fulminant MP pneumonia, however, is infrequent. An exaggerated host cellular immune response has been implicated in the pathogenesis of severe disease. MP primarily causes small-airway involvement, including cellular bronchiolitis and bronchiolitis obliterans, with or without organizing pneumonia.

We describe a life-threatening presentation of MP pneumonia in a previously healthy young adult with no comorbidities. This case underscores that fulminant MP infections tend to occur in otherwise healthy individuals and that empiric therapy for CAP should provide adequate coverage for atypical pathogens. Although MP pneumonia is generally mild, it can progress to severe disease with multi-organ dysfunction syndrome (MODS) in a minority of patients. Underdiagnosis remains a concern due to low clinical suspicion and the limited availability of rapid, reliable diagnostic tests.

Fulminant MP pneumonia appears to be reported more frequently in young, healthy adults. Prophylaxis and evaluation for thromboembolic complications should be considered in selected high-risk situations, given the emerging evidence of MP-associated vascular events.