Erdem GÖNÜLLÜ, Ahmet SOYSAL, Atila TANYELİ, Bülent KARADAĞ, Metin KARABÖCÜOĞLU

Mikoplazma Pnömonisine Bağlı Soğuk Agglutinin Hastalığı, Sık Görülen Hastalığın Az Görülen Komplikasyonu

On dört yaşında kız hasta 3 gündür süren yüksek ateş ve öksürük yakınması ile başvurdu. Yakınmaları başladıktan sonra oseltamivir kullanmaya başladığı öğrenildi. Fizik incelemesinde, sol akciğer alt ve orta zonlarda solunum seslerinde azalma ve sağ akciğerde krepitan ralleri mevcut idi. Laboratuvar incelemesinde hemoglobin 10.6 g/dL, hematokrit %33.5, MCV 76.5 fL, beyaz küre sayısı 5.97 bin /uL, trombosit sayısı 180 bin/uL, CRP 205.6 mg/L, prokalsitonin 1.28 ng/mL idi. Posteroarterior PA akciğer grafisinde, sol akciğer orta ve alt zonlarında lober konsolidasyon, sağ akciğer alt zonda infiltrasyon ile uyumlu görüntü mevcuttu. Hastaya seftriakson, klaritromisin ve teikoplanin tedavileri başlandı. Tedavinin 3. gününde ateşleri düştü ve genel durumu düzeldi. Tedavinin 10. çekilen PA akciğer grafi bulguları belirgin düzeldi ancak alınan kontrol tetkiklerinde hemoglobini 10.8 g/dL, hematokrit %20.6, trombosit sayısı 519 bin/uL olarak bulundu. Hastanın retikülositi % 2.14 direkt ve indirekt Coomb’s testi pozitif bulundu. Soğuk agglutinin titrasyon testi 1/2016, kriyoglobulin ve kriyofibrinojen negatif bulundu. Mycoplasma pneumoniae M. pneumoniae IgM 1.33 pozitif , M. pneumoniae IgG 0.38 negatif , EBV - VCA IgM: 0.62 negatif , EBV - VCA IgG: 196 pozitif bulundu. Hasta klinik olarak izlendi. Ek bir tedavi verilmeden hasta levofloksasin tedavisi ile taburcu edildi. İzleminde hemoliz krizi yine gözlenmedi. Akciğer enfeksiyonu geçiren hastalarda hemoglobin - hematokrit uyuşmazlığı saptandığında soğuk agglutinasyon hastalığı akla getirilmelidir.

Anahtar Kelimeler:

Mycoplasma pneumoniae, soğuk agglutinin, hemolitik anemi

Cold Agglutinin Disease Due to Mycoplasma Pneumonia, Uncommon Complication of a Frequently Seen Disease

A 14-year-old female patient presented with a 3-day history of high fever and cough. It was learnt that she had started to use oseltamivir after her complaints started. Physical examination revealed decreased breath sounds in the lower and middle zones of the left lung and crepitant rales in the right lung. Some laboratory examination test results were as follows: hemoglobin 10.6 g/dL, hematocrit 33.5%, MCV 76.5 fL, white blood cell count 5.97x103 / uL, platelet count 180x103 /uL, CRP 205.6 mg/L, procalcitonin 1.28 ng/mL. Posteroanterior PA chest X-ray showed consolidation in the middle and lower zones of the left lung and infiltration in the lower zone of the right lung. Treatment with ceftriaxone, clarithromycin and teicoplanin was started. On the third day of treatment, their body temperatures fell and her general condition improved. On the 10th day of clinical follow-up, chest X-ray findings improved significantly, In control tests hemoglobin 10.8 g/dL , hematocrit 20.6% , platelet count 519x103 /uL , and reticulocyte count 2.14% , were also evaluated. Direct and indirect Coomb’s tests yielded positive results. The results of some tests perfomed were as follows: Cold agglutinin titration test 1/2016 , Cryoglobulin negative, Cryofibrinogen negative. Mycoplasma pneumoniae M. pneumoniae IgM 1.33 positive , M. pneumoniae IgG 0.38 negative , EBV - VCA IgM: 0.62 negative , EBV - VCA IgG: 196 positive . She was discharged with levofloxacin treatment without any additional treatment. Hemolysis crisis was not observed during the follow-up. Cold agglutination disease should be considered when hemoglobin - hematocrit incompatibility is detected in patients with lung infection.

Keywords:

Mycoplasma pneumoniae, cold agglutinin, hemolytic anemia,

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