Childhood pneumonia: read the smear and clinch the diagnosis

Nandhini K., Kaveri S., Elayaraja S., Umapathy P., Latha Ravichandran


Childhood pneumonia has a myriad of disease causing organisms. Identifying the etiology often helps us predict the natural course of the illness. We would like to share an interesting child with pneumonia by the hematological manifestation of the disease. Case report of this study is a 8 year old boy who presented with high grade fever for eleven days associated with cough. History of skin rashes which worsened following therapy with penicillin. On Examination child had maculopapular rashes predominantly over the trunk with decreased air entry in the left hemithorax. Chest x-ray done showed left lower lobe consolidation hence treated with cephalosporins and macrolide. Counts revealed falling trend in haemoglobin with high MCV count. Peripheral smear done showed agglutinated RBC’S and occasional nucleated RBC’s. Direct Coombs test was positive. With these haematological manifestations child was diagnosed to have Mycoplasma pneumonia which was proven by positive antibodies against Mycoplasma. Child recovered completely and haematological manifestations became passive after four weeks. Cold agglutinin disease is poorly understood affecting 15% of patients with Autoimmune hemolytic anemia. Respiratory tract involvement and extrapulmonary complications manifest in 3-10% and 25% respectively. Antibodies (IgM) against the I antigen on human erythrocyte membranes appear during the course of M. pneumoniae infection and produce a cold agglutinin response. AIHA typically occurs during 2-3rd week after febrile illness with sudden onset of hemolysis which is self-remitting within 4-6 weeks. The conclusion of this study is extra-pulmonary manifestations in a child with pneumonia help in diagnosing the etiology. This in turn helps us like provide rationale management and Predict the natural course of the illness.


Autoimmune, Cold agglutinin disease, Direct coombs test, Haemolytic anemia, Mycoplasma pneumoniae, Pneumonia.

Full Text:



Foering A. Community Acquired Pneumonia; 2019. [online] Scholars Crossing. Available at: https: // digitalcommons.liberty.Edu/kabod/vol 3/issue 3.

Dumke R, Schnee C, Pletz MW, Rupp J, Jacobs E, Sachse K, et al. Mycoplasma pneumoniae and Chlamydia spp. infection in community-acquired pneumonia, Germany, 2011-2012. Emergi Infect Dis. 2015 Mar;21(3):426-34.

Petrone BL, Wolff BJ, DeLaney AA, Diaz MH, Winchell JM. Isothermal detection of Mycoplasma pneumoniae directly from respiratory clinical specimens. J Clin Microbiol. 2015 Sep 1;53(9):2970-6.

Khan FY. Mycoplasma pneumoniae associated with severe autoimmune hemolytic anemia: case report and literature review. Brazil J Infect Dis. 2009 Feb;13(1):77-9.

Youn YS, Lee KY, Hwang JY, Rhim JW, Kang JH, Lee JS, et al. Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia. BMC Pediatrics. 2010 Dec;10(1):48.

Kurugol Z, Onen SS, Koturoglu G. Severe hemolytic anemia associated with mild pneumonia caused by Mycoplasma pneumonia. Case reports in medicine. 2012:1-3.

Vervloet LA, Marguet C, Camargos PA. Infection by Mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias. Brazil J Infect Dis. 2007 Oct;11(5):507-14.

Chao R, Shah K. A Rare Case of Mycoplasma Pneumoniae Infection Causing Cold-Agglutinin Autoimmune Hemolytic Anemia. Chest. 2016 Oct 1;150(4):192A.

Narita M. Classification of extrapulmonary manifestations due to Mycoplasma pneumoniae infection on the basis of possible pathogenesis. Frontiers in microbiology. 2016 Jan 28;7:23.

Swiecicki PL, Hegerova LT, Gertz MA. Cold agglutinin disease. Blood. 2013 Aug 15;122(7):1114-21.

Scribd. Anemia Hemolítica Por Anticuerpos Fríos | Lymphoma | Immune System; 2019. Available at: https:// /document /234504691/Anemia-Hemolitica-Por-Anticuerpos-Frios.