Master of Nursing Student Vanderbilt University Vanderbilt University Nashville, Tennessee, United States
Disclosure(s):
Hannah E. Nightingale, Student Nurse, B.S.: No financial relationships to disclose
Background: Mycoplasma pneumoniae generally results in a mild atypical pneumonia managed with symptomatic care. In rare cases, it can progress to life-threatening acute respiratory distress syndrome. We present a case of a previously healthy 25-year-old female who developed fulminant pneumonia and ARDS requiring veno-venous extracorporeal membrane oxygenation with full recovery.
Methods: The patient presented with a 2-day history of fever (103.8°F), body aches, and a productive cough. Initial chest radiography with bilateral infiltrates worse than clinical presentation. Respiratory viral panel positive for Mycoplasma pneumoniae. With initial treatment with azithromycin and ceftriaxone and supplemental oxygen, she had persistent fevers and worsening hypoxia. Despite the addition of vancomycin, her condition rapidly worsened by day three with hypoxia on high-flow nasal cannula and altered mental status and was rapidly transferred to the ICU for intubation and mechanical ventilation. Her oxygen saturation after intubation remained 69% prompting emergent VV ECMO via femoral-femoral cannulation.
Outcome: After ECMO initiation, PaO2 improved to 120 mmHg within 24 hours, stabilizing at 93-95 mmHg. The patient was extubated the next day and ambulated later that evening on ECMO. She was treated with high-dose corticosteroids and antibiotics narrowed to levofloxacin. She remained on ECMO for seven days, was decannulated on hospital day 9, and discharged home on hospital day 13. She experienced post-intensive care syndrome with muscle weakness and post-traumatic stress disorder. Remarkably, she returned to her graduate studies a week after discharge.
Conclusion: This case highlights a case of severe Mycoplasma pneumoniae requiring VV-ECMO. Similar reports are primarily in younger patients with associated complications. The patient’s recovery supports VV-ECMO as a safe effective treatment for fulminant pneumonia. Uniquely, the patient’s experience as a nursing student on ECMO may aid clinicians in supporting patients.
