Sex: M
Vaccine: COVID19
Symptoms: Chest X-ray, Cytology, Fluorescent in situ hybridisation, Immunohistochemistry, Pneumonia mycoplasmal
Clinical narrative: MYCOPLASMA PNEUMONIA; This spontaneous report was received from literature: This report concerned a 70 year old male of an unspecified race and ethnicity. The objective of this study was to test a series of sputa and nasopharyngeal swabs collected in patients with upper respiratory symptoms for infection by Mycoplasma pneumonia as well as SARS-CoV2 using in situ based methods and then to correlate the results with the clinical information. The patient's height, and weight were not reported. Patient was in good health before vaccination. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported, expiry: unknown) dose and start therapy date were not reported, 1 total administered for covid-19 prophylaxis. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported.  On an unspecified date in early DEC-2022, patient had worsening upper respiratory symptoms with abundant mucous production including sinusitis, and an incessant cough. Patient was afebrile and had complained of a persistent cough with no respiratory distress. The specimens were acquired for testing of COVID-19 related symptoms which in most cases were described as mild. The samples were each tested for SARS-CoV2 (severe acute respiratory syndrome coronavirus 2) by qRTPCR (Quantitative Reverse Transcription polymerase chain reaction) and scored as negative or positive. Patient was tested negative for SARS-CoV2 by qRTPCR. Patient had abundant mucous production with clear sputa which was retrieved and samples placed on glass slides for in situ based testing. He had chest X-ray and diagnosed as negative for pneumonia. A review of the cytologic features of the nasopharygeal swabs and sputa was done after hematoxylin and eosin staining. The SARS-CoV2 negative cytology showed an admixture of normal glandular cells in clusters amongst bland squamous cells with scattered mononuclear cells. In comparison, to the SARS-CoV2 positive cytology specimens which showed extensive degenerative changes in the glandular cells. The degenerative changes were evidenced as nuclear enlargement, degeneration, and cytolysis. Inflammatory cells were present, typically evidenced as mononuclear cells/macrophages with rare neutrophils and eosinophils. In comparison, the patient was ultimately diagnosed as Mycoplasma pneumonia likewise showed degenerated glandular cells. However, though mononuclear cells were evident, there were relatively more neutrophils. Further, mucous was abundant. Immunohistochemistry was next done for SARS-CoV2 spike protein (both S1 and S2 subunits) and RSV (respiratory syncytial virus) proteins blinded to the clinical and viral information. Patient was negative for both  SARS-CoV2 spike protein and RSV. In situ hybridization was done for adenovirus and Mycoplasma pneumonia DNA. An abundant Mycoplasma pneumonia was detected by in situ hybridization. Note that the signal was intense, consistent with large amounts of bacteria, and localized in discrete packets in cells with the cytologic features of macrophages. Patient was treated with doxycycline (100 mg bid for 7 days). The patient's symptoms began to resolve, though not completely, soon after antibiotic therapy was begun. Patient had repeat nasopharyngeal swabs and sputa tested for Mycoplasma pneumonia five days after the onset of antibiotic therapy and there was no Mycoplasma pneumonia were noted by in situ hybridization. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from mycoplasma pneumonia. The authors concluded that other pathogens that were well documented to be able to cause upper respiratory diseases include influenza A, B, RSV, and Mycoplasma pneumonia. Although vaccines were now routinely available for SARS-CoV2 and influenza A, mild infections could still occur in people who had been vaccinated. In situ hybridization for Mycoplasma pneumonia was strongly positive in the present case. The patients were given doxycycline and five days later each sputa/nasopharygeal swab was negative for Mycoplasma pneumonia by in situ hybridization. Hence rapid diagnosis could lead to antibiotic therapy which had been shown to shorten the time period of symptoms which can be clinically problematic with this disease. This report was serious (Other Medically Important Condition). This case, from the same reporter is linked to 20160625425.; Sender's Comments: V0- 20230150033-- Mycoplasma pneumonia- The event has an unknown/unclear temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event. Therefore, the WHO Causality is considered indeterminate. The company causality is considered unassessable.