Yonsei Med J 49(6):1055 - 1059, 2008 DOI 10.3349/ymj.2008.49.6.1055 A Case of Acute Hepatitis with Mycoplasma pneumoniae Infection and Transient Depression of Multiple Coagulation Factors Joo Hee Chang,1 Young Se Kwon,1 Bok Ki Kim,1 Byong Kwan Son,1 Jee Eun Lee,1 Dae Hyun Lim,1 Soon Ki Kim,1 Joon Mi Kim,2 and Sung Kil Kang1 Departments of 1Pediatrics and 2Pathology, Inha University College of Medicine, Incheon, Korea. We report a case of acute severe hepatitis with Mycoplasma pneumoniae (M. pneumoniae) infection and transient depres- sion of multiple coagulation factors. A 5-year-old boy, previously healthy, was admitted with pneumonia. M. pneumoniae infection was confirmed by serology testing. Liver enzymes were elevated on admission without any past medical history. After treatment with azithromycin for 3 days, pneumonia improved, but the hepatitis was acutely aggravated. Partial thromboplastin time (PTT) was prolonged and depression of multiple coagulation factors developed. Liver biopsy revealed features consistent with acute hepatitis. A week later, liver enzymes were nearly normalized spontaneously. Normaliza- tion of prolonged PTT and coagulation factors were also observed several months later. This may be the first case of transient depression of multiple coagulation factors associated with M. pneumoniae infection. Key Words: Hepatitis, Mycoplasma pneumoniae, depression, coagulation factors INTRODUCTION Mycoplasma pneumoniae (M. pneumoniae) is a well known cause of childhood lower respiratory tract infections, reaching up to 40% of community- acquired pneumonia.1 One recent epidemiologic data showed 6 epidemic peaks at 3 - 4 years interval over 18 years in Korean children.2 M. pneumoniae infection is also known for its extrapulmonary manifestations. Nausea, vomiting, and abdominal Received February 26, 2008 Accepted May 10, 2008 Reprint address: requests to Dr. Sung Kil Kang, Department of Pediatrics, Inha University College of Medicine, 7-206, 3-ga, Sinheung-dong, Jung-gu, Incheon 400-711, Korea. Tel: 82-32-890- 2843, Fax: 82-32-890-2844, E-mail: hee715@freechal.com pain are the most common symptoms for ex- trapulmonary manifestations in Korea.3 Hepatitis, hematuria, skin rash, gastroenteritis, and myoperi- carditis were reported in some cases.4 Gastro- intestinal manifestations, such as gastroenteritis, acute and chronic hepatitis, and pancreatitis have been reported.4,5 However, severe hepatitis with depressed coagulation factors in children with M. pneumoniae infection has rarely been reported. We report a child with acute severe hepatitis with M. pneumoniae infection, accompanied with depressed multiple coagulation factors. CASE REPORT A 5-year-old boy presented with fever and cough for 6 days. He also developed anorexia and lethargy, and then was admitted to Inha University Hospital. Past medical history included atopic dermatitis during infancy. Hepatitis B vaccination was administered as scheduled. Six months prior to admission at a routine health check up, the serum liver enzymes were normal. The patient had no history of a bleeding tendency. There was no family history of hepatitis or liver disease, but the patient had a younger brother with extrinsic asthma. The patient had fever, cough and nasal ob- struction for 6 days. He had abdominal pain, but no vomiting or diarrhea. On admission, he appeared sick. His heart rate was 100/min, respira- tory rate 24/min and body temperature 38.7°C. Inspiratory crackles were auscultated at both lung Yonsei Med J Vol. 49, No. 6, 2008