6-Year-Old Girl Successfully Treated for Mycoplasma Pneumonia with Targeted Therapy Approach

In pediatric medicine, timely and accurate diagnosis plays a crucial role in ensuring effective treatment outcomes—especially when dealing with respiratory infections like mycoplasma pneumonia. This case study highlights the journey of a 6-year-old girl who presented with persistent fever and cough, later diagnosed with mycoplasma pneumonia accompanied by mild pleural effusion. Through a carefully tailored treatment plan involving intravenous antibiotics, anti-inflammatory agents, mucolytic therapy, and airway clearance techniques, the patient achieved full clinical recovery within nine days of hospitalization. The story underscores the importance of precise diagnostic evaluation and individualized care in pediatric respiratory illness.

Case Overview: A Pediatric Patient with Atypical Pneumonia

Patient Profile: Female, 6 years oldDiagnosis: Mycoplasma pneumonia with left-sided pleural effusionHospital: Chaoyang Second HospitalDate of Admission: May 2022Treatment Duration: 9 days inpatient careTherapeutic Approach: Intravenous azithromycin, intravenous prednisolone acetate, ambroxol hydrochloride infusion, nebulized acetylcysteine, and mechanical chest physiotherapyOutcome: Complete resolution of symptoms and radiological improvements confirmed by follow-up CT scan

Initial Presentation and Clinical Assessment

The child was brought to the emergency department after six days of intermittent fever and worsening cough. According to her parents, she had developed a low-grade fever reaching up to 38.6°C twice daily without chills or seizures. Although ibuprofen provided temporary relief, the cough persisted—characterized as paroxysmal and productive, with difficulty expectorating thick mucus. Post-cough vomiting occurred occasionally, further affecting her comfort and appetite.

Prior attempts at home treatment included oral roxithromycin and herbal cough syrup, followed by outpatient intravenous cefalexin, tanreqing injection, and ambroxol over five days—with no significant improvement. As symptoms failed to resolve, the family sought specialized care at our facility.

Physical Examination Findings

On admission, vital signs showed a heart rate of 104 bpm, respiratory rate of 32 breaths per minute (indicative of tachypnea), and normal blood pressure (106/67 mmHg). The patient was alert and responsive, though breathing appeared labored. No rashes or petechiae were observed. Oropharyngeal examination revealed pharyngeal congestion and grade I tonsillar enlargement. Lung auscultation detected coarse breath sounds bilaterally, with scattered crackles and minimal rhonchi—more prominent on the left side. Cardiac and abdominal exams were unremarkable, and neurological screening—including assessment of deep tendon reflexes and meningeal signs—was negative. Capillary refill time was within acceptable limits (2 seconds).

Diagnostics: Confirming Mycoplasma Infection

Laboratory tests revealed leukocytosis (WBC: 12.4 × 10⁹/L) with elevated neutrophils (61.8%) and increased monocytes (13.2%), while lymphocyte percentage was slightly reduced (21.1%). Absolute monocyte count was also elevated (1.6 × 10⁹/L), suggesting an ongoing immune response. Hemoglobin and platelet levels remained within normal ranges.

Serological testing for Mycoplasma pneumoniae IgM antibodies returned positive at 6.55 COI, confirming recent infection. Chest computed tomography (CT) scans showed patchy and confluent areas of consolidation predominantly in the lower lobes, especially on the left, with visible air bronchograms indicating alveolar involvement. A narrow strip of fluid density was noted posteriorly in the left pleural space, consistent with minimal pleural effusion. No mediastinal shift, enlarged lymph nodes, or structural abnormalities were identified.

Personalized Treatment Strategy and Progression

Given the confirmed diagnosis of mycoplasma pneumonia with inflammatory complications, a multi-modal treatment approach was initiated. After obtaining informed consent, intravenous azithromycin was administered to target the atypical bacterial pathogen effectively. Azithromycin is preferred in pediatric cases due to its favorable safety profile and high tissue penetration in lung parenchyma.

To address inflammation and reduce exudative processes contributing to pleural effusion, intravenous prednisolone acetate was added to the regimen. Concurrently, ambroxol hydrochloride was given intravenously to enhance mucociliary clearance and liquefy viscous secretions. On day five of hospitalization, intravenous ambroxol was discontinued and transitioned to nebulized acetylcysteine, which acts as a potent mucolytic agent by breaking disulfide bonds in mucus proteins.

Airway Clearance and Supportive Care

Mechanical chest physiotherapy was introduced to facilitate sputum expulsion, particularly important in young children who lack the strength to cough effectively. This non-invasive intervention helped prevent mucus plugging and secondary bacterial superinfection. Throughout her stay, liver function and complete blood counts were monitored regularly to ensure medication safety.

Positive Clinical Response and Discharge Planning

By the third day of treatment, the patient's fever had resolved completely. Cough frequency began decreasing from day five onward, and sputum production increased—a sign of improved airway clearance. With continued nebulization and chest physiotherapy, expectoration became easier, and overall energy levels improved significantly.

On day eight, a repeat chest CT demonstrated near-complete resolution of pulmonary infiltrates. The previously observed consolidations had cleared, and the small pleural effusion was no longer detectable. Lung fields appeared clear, with normal bronchovascular markings and no mediastinal abnormalities. Based on these findings and stable vitals, the patient was discharged on day nine with no residual symptoms.

Post-Discharge Guidance for Long-Term Wellness

While the immediate infection was successfully managed, long-term health maintenance remains essential. Parents were advised to schedule a follow-up clinic visit one week post-discharge to assess blood counts and liver enzymes, ensuring there were no delayed adverse effects from medications.

Key recommendations included:

• Maintaining good indoor air quality through regular ventilation and humidity control
• Dressing appropriately for weather changes to avoid cold exposure
• Wearing masks in crowded environments to minimize risk of viral or bacterial reinfection
• Encouraging light outdoor physical activity to boost immunity
• Providing balanced, nutrient-rich meals with emphasis on hydration and digestive hygiene

These preventive strategies aim to reduce recurrence risks and support robust immune development during early childhood.

Clinical Reflections: Precision Medicine in Pediatrics

This case reaffirms that accurate diagnostics are the foundation of successful pediatric care. Early identification of Mycoplasma pneumoniae allowed for targeted antimicrobial use, avoiding unnecessary broad-spectrum antibiotics. The judicious addition of corticosteroids helped mitigate inflammation-related complications such as pleural effusion, shortening recovery time.

Parents expressed gratitude for the transparent communication and evidence-based decisions throughout the treatment process. Their trust underscored the value of shared decision-making in pediatric settings. Importantly, this experience highlights a critical message for caregivers: if a child exhibits prolonged fever, persistent cough, or breathing difficulties—even after initial treatments—it's vital to seek prompt medical reassessment rather than waiting.

Early intervention not only improves outcomes but can prevent progression to more severe respiratory complications. In managing pediatric pneumonia, precision, patience, and proactive care make all the difference.