□ PICTURES IN CLINICAL MEDICINE □Thromboembolism Supervened on Eosinophilia Induced byMycoplasma Pneumonia
Kazuho Morichika, Sawako Nakachi, Takeaki Tomoyose and Hiroaki Masuzaki
Key words: catastrophic thromboembolism, pulmonary embolism, enhanced computed tomography imaging,
mycoplasma pneumonia, eosinophilia(Intern Med 55: 2741-2742, 2016)(DOI: 10.2169/internalmedicine.55.6953)

An 18-year-old man, who was diagnosed with mycoplasma pneumonia 3 weeks previously, visited our hospitalwith sustained pain on the bilateral inferior limbs and back.
Laboratory investigations revealed eosinophilia (18×102/μL)
and an elevated D-dimer level (21 μg/mL) in the plasma. Aline of data excluded the possibility of drug allergies. In addition, there were no drug and other allergy related events.
His eosinophil count in the peripheral blood had remained
within the normal range. When the patient was diagnosed
with mycoplasma pneumonia, the value was markedly elevated around 50×102/μL, which was strongly correlated withthe disease activity during the course of treatment. Contrastenhanced computed tomography demonstrated left pulmonary embolism (Picture a, white arrow) and right renal veinthrombosis with a swollen kidney (Picture b, yellow andwhite arrows). Bilateral femoral and popliteal veins thromboses were also detected (Picture c and d, white arrows). No
supporting data were observed regarding abnormalities ofcoagulation or fibrinolysis, including the presence of pertinent antibodies. The extension of systemic thromboembolism was well correlated with the change in eosinophil
count in the circulation, suggesting that the thromboembolism was caused by mycoplasma pneumonia. The patientcompletely recovered following anticoagulant therapy withnormalization of eosinophilia and the D-dimer level. It has
been reported that approximately 10% of patients with mycoplasma pneumonia are complicated with transient eosinophilia (1). Cytoplasmic granules of differentiated eosinophils
are known to evoke hypercoagulability via the inhibition ofthrombomodulin cofactors (2). To the best of our knowledge, this is the first demonstration of thromboembolism induced by transient eosinophilia in a case of mycoplasma
pneumonia.
Picture.
Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology (Second Department of Medicine), Graduate School of Medicine, University of the Ryukyus, Japan
Received for publication December 8, 2015; Accepted for publication February 3, 2016
Correspondence to Dr. Hiroaki Masuzaki, hiroaki@med.u-ryukyu.ac.jp2741

Intern Med 55: 2741-2742, 2016

DOI: 10.2169/internalmedicine.55.6953

The authors state that they have no Conflict of Interest (COI).
Acknowledgement
We are grateful to Y. Kishimoto, M. Hirata, I. Asato, C.
Noguchi and M. Shimoji for their secretarial assistance. We appreciate the clinical cooperation of Dr. M. Tsuchida at the Department of General Medicine, Okinawa-Chubu-Tokushukai Hospital. KM treated the patient, and KM, SN, TT and HM prepared
the manuscript.

References

Changes in blood eosinophil numbers during Mycoplasma pneumoniae infection in wheezing and non-wheezing, atopic and nonatopic children. Pediatr Int 50: 718-721, 2008.
2. Mukai HY, Ninomiya H, Ohtani K, Nagasawa T, Abe T. Major basic protein binding to thrombomodulin potentially contributes tothe thrombosis in patients with eosinophilia. Br J Haematol 90:892-899, 1995.
The Internal Medicine is an Open Access article distributed under the Creative
Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Toview the details of this license, please visit (https://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Defilippi AC, Silvestri M, Giacchino R, Di Pietro P, Rossi GA.

Ⓒ 2016 The Japanese Society of Internal Medicine
http://www.naika.or.jp/imonline/index.html

2742