{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T14:23:21Z","timestamp":1788791001948,"version":"build-2803163510"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018542","name":"Sichuan Provincial Natural Science Foundation","doi-asserted-by":"crossref","award":["Project No: 2023NSFSC1469"],"award-info":[{"award-number":["Project No: 2023NSFSC1469"]}],"id":[{"id":"10.13039\/501100018542","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      We report the first documented case of macrolide-resistant\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      (MRMP) infection simultaneously complicated by both plastic bronchitis (PB) and Kawasaki disease (KD), expanding our understanding of severe MRMP-associated immune dysregulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 7-year-old male presented with persistent high fever (39.8\u00a0\u00b0C), paroxysmal cough, and mucocutaneous manifestations. Diagnosis was established through multiple modalities: chest CT revealed bilateral consolidation with segmental airway narrowing; bronchoscopy demonstrated characteristic bronchial casts with focal mucosal necrosis; echocardiography showed right coronary artery dilation (Z-score\u2009+\u20092.334); and targeted next-generation sequencing (tNGS) identified MRMP with the A2063G mutation, alongside Streptococcus pneumoniae and Staphylococcus aureus co-infections. Treatment included oral doxycycline after macrolide failure, high-dose IVIG (2\u00a0g\/kg), methylprednisolone (3\u00a0mg\/kg\/day), and therapeutic bronchoscopy. Complete resolution of coronary dilation and respiratory symptoms was achieved by the one-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This unprecedented case demonstrates how MRMP infection can trigger simultaneous, severe immune-mediated complications through shared inflammatory pathways. In regions with high MRMP prevalence (&gt;\u200990%), clinicians should maintain vigilance for atypical manifestations in refractory pneumonia. Early bronchoscopy and tNGS for comprehensive pathogen identification are essential, while combined therapy with appropriate alternative antibiotics, corticosteroids, and IVIG can effectively manage these complex cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial number<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-12063-2","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T11:52:50Z","timestamp":1764071570000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A case report of severe Mycoplasma pneumoniae pneumonia complicated by plastic bronchitis and Kawasaki disease"],"prefix":"10.1186","volume":"25","author":[{"given":"Hongjia","family":"Chen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanmin","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yijie","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"12063_CR1","doi-asserted-by":"publisher","first-page":"2482703","DOI":"10.1080\/22221751.2025.2482703","volume":"14","author":"Y Sun","year":"2025","unstructured":"Sun Y, Li P, Jin R, Liang Y, Yuan J, Lu Z, et al. Characterizing the epidemiology of Mycoplasma pneumoniae infections in China in 2022\u20132024: a nationwide cross-sectional study of over 1.6 million cases. Emerg Microbes Infections. 2025;14:2482703. https:\/\/doi.org\/10.1080\/22221751.2025.2482703.","journal-title":"Emerg Microbes Infections"},{"key":"12063_CR2","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1007\/s12519-024-00831-0","volume":"20","author":"Y-S Wang","year":"2024","unstructured":"Wang Y-S, Zhou Y-L, Bai G-N, Li S-X, Xu D, Chen L-N, et al. Expert consensus on the diagnosis and treatment of macrolide-resistant Mycoplasma pneumoniae pneumonia in children. World J Pediatr. 2024;20:901\u201314. https:\/\/doi.org\/10.1007\/s12519-024-00831-0.","journal-title":"World J Pediatr"},{"key":"12063_CR3","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1007\/s12519-023-00793-9","volume":"20","author":"X-B Zhang","year":"2024","unstructured":"Zhang X-B, He W, Gui Y-H, Lu Q, Yin Y, Zhang J-H, et al. Current Mycoplasma pneumoniae epidemic among children in shanghai: unusual pneumonia caused by usual pathogen. World J Pediatr. 2024;20:5\u201310. https:\/\/doi.org\/10.1007\/s12519-023-00793-9.","journal-title":"World J Pediatr"},{"key":"12063_CR4","doi-asserted-by":"publisher","first-page":"e22213","DOI":"10.1016\/j.heliyon.2023.e22213","volume":"9","author":"J Ma","year":"2023","unstructured":"Ma J, Guo P, Mei S, Li M, Yu Z, Zhang Y, et al. Influence of COVID-19 pandemic on the epidemiology of Mycoplasma pneumoniae infections among hospitalized children in Henan, China. Heliyon. 2023;9:e22213. https:\/\/doi.org\/10.1016\/j.heliyon.2023.e22213.","journal-title":"Heliyon"},{"key":"12063_CR5","doi-asserted-by":"publisher","first-page":"1449511","DOI":"10.3389\/fmicb.2024.1449511","volume":"15","author":"Y Chen","year":"2024","unstructured":"Chen Y, Jia X, Gao Y, Ren X, Du B, Zhao H, et al. Increased macrolide resistance rate of Mycoplasma pneumoniae correlated with epidemic in Beijing, China in 2023. Front Microbiol. 2024;15:1449511. https:\/\/doi.org\/10.3389\/fmicb.2024.1449511.","journal-title":"Front Microbiol"},{"key":"12063_CR6","doi-asserted-by":"publisher","first-page":"1405710","DOI":"10.3389\/fmicb.2024.1405710","volume":"15","author":"M Jiang","year":"2024","unstructured":"Jiang M, Zhang H, Yao F, Lu Q, Sun Q, Liu Z, et al. Influence of non-pharmaceutical interventions on epidemiological characteristics of Mycoplasma pneumoniae infection in children during and after the COVID-19 epidemic in Ningbo, China. Front Microbiol. 2024;15:1405710. https:\/\/doi.org\/10.3389\/fmicb.2024.1405710.","journal-title":"Front Microbiol"},{"key":"12063_CR7","doi-asserted-by":"publisher","first-page":"1437731","DOI":"10.3389\/fmed.2024.1437731","volume":"11","author":"Z Guo","year":"2024","unstructured":"Guo Z, Gu S, Tian Z, Du B. A comprehensive review of Mycoplasma pneumoniae infection in chronic lung diseases: recent advances in Understanding asthma, COPD, and bronchiectasis. Front Med. 2024;11:1437731. https:\/\/doi.org\/10.3389\/fmed.2024.1437731.","journal-title":"Front Med"},{"key":"12063_CR8","doi-asserted-by":"publisher","first-page":"1088725","DOI":"10.3389\/fimmu.2022.1088725","volume":"13","author":"Z Zhang","year":"2022","unstructured":"Zhang Z, Dou H, Tu P, Shi D, Wei R, Wan R, et al. Serum cytokine profiling reveals different immune response patterns during general and severe Mycoplasma pneumoniae pneumonia. Front Immunol. 2022;13:1088725. https:\/\/doi.org\/10.3389\/fimmu.2022.1088725.","journal-title":"Front Immunol"},{"key":"12063_CR9","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1186\/s12879-021-06783-4","volume":"21","author":"Q Cheng","year":"2021","unstructured":"Cheng Q, Zhang H, Shang Y, Zhao Y, Zhang Y, Zhuang D, et al. Clinical features and risk factors analysis of bronchitis obliterans due to refractory Mycoplasma pneumoniae pneumonia in children: a nomogram prediction model. BMC Infect Dis. 2021;21:1085. https:\/\/doi.org\/10.1186\/s12879-021-06783-4.","journal-title":"BMC Infect Dis"},{"key":"12063_CR10","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1038\/s41584-021-00709-9","volume":"17","author":"C Sharma","year":"2021","unstructured":"Sharma C, Ganigara M, Galeotti C, Burns J, Berganza FM, Hayes DA, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison. Nat Rev Rheumatol. 2021;17:731\u201348. https:\/\/doi.org\/10.1038\/s41584-021-00709-9.","journal-title":"Nat Rev Rheumatol"},{"key":"12063_CR11","doi-asserted-by":"publisher","first-page":"1521954","DOI":"10.3389\/fped.2025.1521954","volume":"13","author":"R Ma","year":"2025","unstructured":"Ma R, Bai T, Yuan B, Zhang L, Li S, Ma L, et al. Risk factor analysis of plastic bronchitis among 126 children with macrolide-resistant Mycoplasma pneumoniae pneumonia with mutations at the A2063G site after bronchoscopy examination: a nomogram prediction model. Front Pediatr. 2025;13:1521954. https:\/\/doi.org\/10.3389\/fped.2025.1521954.","journal-title":"Front Pediatr"},{"key":"12063_CR12","doi-asserted-by":"publisher","first-page":"1382","DOI":"10.3201\/eid2607.200017","volume":"26","author":"Y-C Chen","year":"2020","unstructured":"Chen Y-C, Hsu W-Y, Chang T-H. Macrolide-Resistant Mycoplasma pneumoniae infections in pediatric Community-Acquired Pneumonia - 26, number 7\u2014July 2020 - Emerging infectious diseases journal - CDC. Emerg Infect Dis. 2020;26:1382\u201391. https:\/\/doi.org\/10.3201\/eid2607.200017.","journal-title":"Emerg Infect Dis"},{"key":"12063_CR13","doi-asserted-by":"publisher","unstructured":"Wu T-H, Fang Y-P, Liu F-C, Pan H-H, Yang Y-Y, Song C-S, et al. Macrolide-Resistant Mycoplasma pneumoniae infections among children before and during COVID-19 Pandemic, Taiwan, 2017\u20132023. Emerg Infect Dis. 2024;30. https:\/\/doi.org\/10.3201\/eid3008.231596.","DOI":"10.3201\/eid3008.231596"},{"key":"12063_CR14","doi-asserted-by":"publisher","first-page":"1496829","DOI":"10.3389\/fcimb.2025.1496829","volume":"15","author":"Y Fang","year":"2025","unstructured":"Fang Y, Xie P, Zhang X, Zhang Y, Yang N, Shi Y, et al. Rapid detection of Mycoplasma pneumoniae CARDS toxin in clinical respiratory specimens by a loop-mediated isothermal amplification assay. Front Cell Infect Microbiol. 2025;15:1496829. https:\/\/doi.org\/10.3389\/fcimb.2025.1496829.","journal-title":"Front Cell Infect Microbiol"},{"key":"12063_CR15","doi-asserted-by":"publisher","first-page":"106865","DOI":"10.1016\/j.micpath.2024.106865","volume":"195","author":"N Xu","year":"2024","unstructured":"Xu N, Fan L, Li L, Guo Y. Exploring the pathogenicity of Mycoplasma pneumoniae: focus on community-acquired respiratory distress syndrome toxins. Microb Pathog. 2024;195:106865. https:\/\/doi.org\/10.1016\/j.micpath.2024.106865.","journal-title":"Microb Pathog"},{"key":"12063_CR16","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1007\/s00284-022-03103-0","volume":"80","author":"J Hu","year":"2023","unstructured":"Hu J, Ye Y, Chen X, Xiong L, Xie W, Liu P. Insight into the pathogenic mechanism of Mycoplasma pneumoniae. Curr Microbiol. 2023;80:14. https:\/\/doi.org\/10.1007\/s00284-022-03103-0.","journal-title":"Curr Microbiol"},{"key":"12063_CR17","doi-asserted-by":"publisher","first-page":"1310134","DOI":"10.3389\/fimmu.2023.1310134","volume":"14","author":"G Lu","year":"2024","unstructured":"Lu G, Li X, Tang J, Jin Y, Wang Y, Zhou K, et al. Mycoplasma infection aggravates cardiac involvements in Kawasaki diseases: a retrospective study. Front Immunol. 2024;14:1310134. https:\/\/doi.org\/10.3389\/fimmu.2023.1310134","journal-title":"Front Immunol"},{"key":"12063_CR18","doi-asserted-by":"publisher","first-page":"738215","DOI":"10.3389\/fped.2021.738215","volume":"9","author":"S-W Huang","year":"2022","unstructured":"Huang S-W, Lin S-C, Chen S-Y, Hsieh K-S. Kawasaki disease with combined cholestatic hepatitis and Mycoplasma pneumoniae infection: A case report and literature review. Front Pediatr. 2022;9:738215. https:\/\/doi.org\/10.3389\/fped.2021.738215.","journal-title":"Front Pediatr"},{"key":"12063_CR19","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1186\/s12879-024-10070-3","volume":"24","author":"X Song","year":"2024","unstructured":"Song X, Zhou N, Lu S, Gu C, Qiao X. New-generation tetracyclines for severe macrolide-resistant Mycoplasma pneumoniae pneumonia in children: a retrospective analysis. BMC Infect Dis. 2024;24:1166. https:\/\/doi.org\/10.1186\/s12879-024-10070-3.","journal-title":"BMC Infect Dis"},{"key":"12063_CR20","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1097\/INF.0000000000004568","volume":"44","author":"E Bolormaa","year":"2025","unstructured":"Bolormaa E, Park JY, Choe YJ, Kang CR, Choe SA, Mylonakis E. Treatment of Macrolide-resistant Mycoplasma pneumoniae pneumonia in children: A Meta-analysis of macrolides versus tetracyclines. Pediatr Infect Disease J. 2025;44:200\u20136. https:\/\/doi.org\/10.1097\/INF.0000000000004568.","journal-title":"Pediatr Infect Disease J"},{"key":"12063_CR21","doi-asserted-by":"publisher","first-page":"112422","DOI":"10.1016\/j.ijporl.2025.112422","volume":"195","author":"A Sharifi","year":"2025","unstructured":"Sharifi A, Rahbar R, Fynn-Thompson F, Farasat E, Pugi J, Samadizadeh S, et al. Plastic bronchitis in pediatrics: A systematic review of etiologies, clinical presentations, treatments, and prognosis. Int J Pediatr Otorhinolaryngol. 2025;195:112422. https:\/\/doi.org\/10.1016\/j.ijporl.2025.112422.","journal-title":"Int J Pediatr Otorhinolaryngol"},{"key":"12063_CR22","doi-asserted-by":"publisher","first-page":"2338","DOI":"10.3390\/diagnostics13142338","volume":"13","author":"P Nadig","year":"2023","unstructured":"Nadig P, Joshi V, Pilania R, Kumrah R, Kabeerdoss J, Sharma S, et al. Intravenous Immunoglobulin in Kawasaki Disease\u2014Evolution and pathogenic mechanisms. Diagnostics. 2023;13:2338. https:\/\/doi.org\/10.3390\/diagnostics13142338.","journal-title":"Diagnostics"},{"key":"12063_CR23","doi-asserted-by":"publisher","first-page":"1636339","DOI":"10.3389\/fped.2025.1636339","volume":"13","author":"A Marchesi","year":"2025","unstructured":"Marchesi A, Recupero R, Sardella L, Babini R, Gargiullo L, Tarissi De Jacobis I, et al. The protective role of steroids on coronary arteries in the acute phase of Kawasaki disease for high risk patients: a retrospective study. Front Pediatr. 2025;13:1636339. https:\/\/doi.org\/10.3389\/fped.2025.1636339.","journal-title":"Front Pediatr"},{"key":"12063_CR24","doi-asserted-by":"publisher","first-page":"1054788","DOI":"10.3389\/fimmu.2022.1054788","volume":"13","author":"T Wang","year":"2022","unstructured":"Wang T, Sun H, Lu Z, Jiang W, Dai G, Huang L, et al. The CARDS toxin of Mycoplasma pneumoniae induces a positive feedback loop of type 1 immune response. Front Immunol. 2022;13:1054788. https:\/\/doi.org\/10.3389\/fimmu.2022.1054788.","journal-title":"Front Immunol"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-12063-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-025-12063-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-025-12063-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T11:52:51Z","timestamp":1764071571000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcinfectdis.biomedcentral.com\/articles\/10.1186\/s12879-025-12063-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":24,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["12063"],"URL":"https:\/\/doi.org\/10.1186\/s12879-025-12063-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]},"assertion":[{"value":"17 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 October 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Committee of Chengdu Women\u2019s and Children\u2019s Central Hospital (Ethics Approval No: 2025\u301415\u3015).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent for publication of the patient\u2019s personal and clinical details, as well as any accompanying and potentially identifying images, was obtained from the patient\u2019s guardians.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1646"}}