When a simple pneumonia isn't so simple: a rare case of mycoplasma pneumoniae induced pancreatitis

Abstract

This case highlights an uncommon extrapulmonary complication of Mycoplasma pneumoniae: acute pancreatitis. It underscores the importance of considering the systemic effects of respiratory infections. A 36-year-old previously healthy male presented with a five-day history of cough, fever, and malaise. A chest X-ray confirmed pneumonia, and he was started on antibiotics for atypical pneumonia. On the third day of hospitalization, he developed sudden, severe epigastric pain radiating to his back, accompanied by nausea and vomiting. On examination, he was febrile, tachycardic, and exhibited epigastric tenderness. Laboratory results showed significantly elevated amylase (432 U/L) and lipase (1,056 U/L), confirming acute pancreatitis. A CT scan demonstrated pancreatic edema but no gallstones or biliary obstruction. Serologic testing revealed elevated M. pneumoniae IgM antibodies, supporting a recent infection and its potential association with pancreatitis. The patient was managed conservatively with intravenous fluids, analgesia, and bowel rest. His condition gradually improved, and he was discharged in stable condition after seven days. Acute pancreatitis is a rare but recognized extrapulmonary manifestation of M. pneumoniae infection. The exact pathophysiology remains unclear, but proposed mechanisms include immune-mediated inflammation, direct bacterial invasion, and immune complex deposition in pancreatic tissue. This case highlights the need for clinicians to remain vigilant for atypical presentations in patients with M. pneumoniae infections. Early recognition of such complications can guide appropriate management and improve patient outcomes. This case underscores the potential for M. pneumoniae to cause extrapulmonary complications, including acute pancreatitis. Clinicians should consider this rare association in patients with M. pneumoniae who develop unexplained abdominal symptoms. Awareness of these complications is essential for timely diagnosis and effective management.