{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T05:07:42Z","timestamp":1779944862140,"version":"3.53.1"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      In the post-pandemic era, the co-detection of SARS-CoV-2 and\n                      <jats:italic>Mycoplasma pneumoniae<\/jats:italic>\n                      (\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      ) is increasingly recognized in children, but its full clinical spectrum remains poorly characterized.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case report<\/jats:title>\n                    <jats:p>\n                      We describe a previously healthy 20-month-old girl who presented with sepsis, acute liver failure (ALT, 17,134 U\/L), and extreme hyperinflammation (ferritin, 10,929.6\u202fng\/mL; interleukin-6 [IL-6], 74\u202fpg\/ml) associated with SARS-CoV-2 and\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      co-detection. Despite initial improvement in the liver function with glucocorticoid therapy, she subsequently developed a secondary thrombotic microangiopathy (TMA)-like phenomenon characterized by severe thrombocytopenia (52\u202f\u00d7\u202f10\n                      <jats:sup>9<\/jats:sup>\n                      \/L), microangiopathic hemolysis, and acute kidney injury (creatinine, 181.5\u202f\u03bcmol\/L). A comprehensive etiological workup, including negative complement gene testing (whole-exome sequencing, whole-genome sequencing, and copy number variation analysis), supported a diagnosis of severe infection-associated secondary TMA-like phenomenon. The patient recovered after comprehensive supportive care, antimicrobial therapy, glucocorticoids, and prophylactic anticoagulation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      This case delineates a clinical sequence from acute liver failure to a secondary TMA-like phenomenon associated with SARS-CoV-2 and\n                      <jats:italic>M. pneumoniae<\/jats:italic>\n                      co-detection. The transient C3 consumption with spontaneous recovery, together with negative complement gene testing, was documented. This report highlights the importance of vigilant monitoring for a secondary TMA-like phenomenon in children with severe hyperinflammation and co-detection of viral and bacterial pathogens.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1849049","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T04:55:48Z","timestamp":1779944148000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute liver failure and secondary TMA-like phenomenon following SARS-CoV-2 and Mycoplasma pneumoniae co-detection in a child: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Qian","family":"Liu","sequence":"first","affiliation":[{"name":"Western Emergency Department, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Kang","sequence":"additional","affiliation":[{"name":"Western Emergency Department, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjuan","family":"Zeng","sequence":"additional","affiliation":[{"name":"Western Emergency Department, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuan","family":"Long","sequence":"additional","affiliation":[{"name":"Western Emergency Department, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science & Technology","place":["Wuhan, Hubei, 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