肺炎黴漿菌和腺病毒共同感染引起自體免疫溶血性貧血案例報告

A child had a hemolytic anemia during the co-infection of Mycoplasma pneumoniae and adenovirus

一名三歲男童，有紅色尿和黃疸，就醫前4天有大量咳嗽、流鼻涕和鼻塞，發燒2天。 實驗室檢查顯示自體 免疫溶血性貧血 (Hb8.2g/dL)，胸部X光片顯示右肺間質浸潤。入院第一天給予口服 macrolide。第二天， 呼吸道多重聚合酶連鎖反應 (PCR) 套組檢驗顯示肺炎黴漿菌和腺病毒合併感染，Hb降至 7.2 g/dL，住院 第3天處方口服類固醇 prednisolone。住院第6天Hb 8.5 g / dL，恢復良好出院並持續口服 prednisolone， 一週回診Hb升至10.2 g/dL，在肺炎黴漿菌IgG和IgM抗體均呈陽性後，血液檢測確認為最近感染。 本文報 導一例肺炎黴漿菌和腺病毒共同感染引起的自體免疫溶血性貧血，採用多重聚合酶連鎖反應套組同時鑑定 病毒和細菌，可為患者提供早期評估和即時治療策略。

We report a 3-year-old boy presenting with a 1-day history of red urine and jaundice. He had productive cough, rhinorrhea and nasal obstruction during the last 4 days and was febrile for 2 days. The laboratory tests indicated autoimmune hemolytic anemia. Chest radiography showed inte rstitial infiltration with haziness of the right lung. Oral macrolide (Zithromax) was given the first day on a dmission. The next day, a respiratory multiplex polymerase chain reaction (PCR) panel test revealed Myco plasma pneumoniae and adenovirus co-infections. Oral prednisolone (1.1 mg/kg/day) was prescribed on hospital day 3 due to progressive anemia (7.2 g/dL). The fever subsided, and the patient showed a favorable recovery, and was discharged on the 6th day with an Hb level of 8.5 g/dL. The Hb level was elevated to 10.2 g/dL with a 7-day administration of oral prednisolone. M. pneumoniae was later confirmed by a bloo d test after discharge of both positive immunoglobulin IgG and IgM antibodies, indicative of a recent infection. We reported a child had a hemolytic anemia during the co-infection of Mycoplasma pneumoniae and adenovirus, and the use of multiplex polymerase chain reaction (PCR) viral and bacterial pathogens panel may provide an early evaluation and a timely therapeutic strategy for the patient.