Coexistence of Mycoplasma Pneumonia and Pulmonary Embolism as a Cause of Acute Chest Syndrome in a Child with Sickle Cell Disease.

Sickle cell disease (SCD) is a chronic, inherited hemoglobinopathy associated with significant morbidity and mortality, particularly in pediatric patients. Among its numerous complications, acute chest syndrome (ACS) remains one of the leading causes of hospitalization and death in children with SCD. ACS is a multifactorial condition, often precipitated by infection but also involving noninfectious causes such as thromboembolism. We present an 8-year-old girl with homozygous SCD who developed a protracted, atypical ACS. Initial findings suggested lobar pneumonia with serologic evidence of Mycoplasma pneumoniae infection. Despite antibiotics, persistent symptoms prompted CT, revealing both pneumonia and an acute pulmonary embolism (PE). The patient received therapeutic anticoagulation and transfusion support, leading to complete resolution of PE at six-month follow-up. This case highlights the critical importance of a broad differential diagnosis in pediatric SCD-related ACS; thromboembolic complications must be actively considered, especially in atypical or refractory cases. We hypothesize that Mycoplasma pneumoniae infection may synergistically exacerbate the inherent hypercoagulable state in SCD, contributing to PE development. This potential link warrants further investigation. Early diagnosis, comprehensive management, and proactive measures like hydroxyurea and long-term pulmonary monitoring are crucial for improving outcomes.