REVIEW Mycoplasma pneumoniae: nervous system complications in childhood and review of the literature Uluç Yiş & Semra Hız Kurul & Handan Çakmakçı & Eray Dirik Received: 12 October 2007 / Revised: 29 February 2008 / Accepted: 29 February 2008 / Published online: 28 May 2008 # Springer-Verlag 2008 Abstract Mycoplasma pneumoniae is an important patho- gen which causes nervous system disorders during or after the course of a respiratory tract infection. The exact pathogenic mechanism which causes neurological disorders still remains unknown. Although meningoencephalitis and acute disseminated encephalomyelitis are common compli- cations, there are few cases of acute transverse myelitis and isolated abducens nerve palsy associated with M. pneumo- niae infection in childhood. The association between ocular myasthenia gravis and M. pneumoniae infection has not been described before. Here, we describe five patients with different nervous system complications associated with M. pneumoniae infection and discuss the pathological features of central nervous system involvement. Keywords Nervous system . Complication . Mycoplasma pneumoniae Introduction Mycoplasma pneumoniae is a common cause of respiratory tract illness in children. One of the most common extrapulmonary manifestations is a disorder of the central nervous system, and central nervous system involvement is estimated to complicate 0.1% of all M. pneumoniae infections [12]. M. pneumoniae is considered as one of the major causes of encephalitis in children and 5–10% of these cases is attributed to M. pneumoniae. Meningitis, meningoencephalitis, cerebellitis, polyneuropathy, acute disseminated encephalomyelitis, and Guillain-Barre syn- drome are the most common neurological manifestations [23, 29], and there are few cases of acute transverse myelitis and isolated abducens nerve palsy associated with M. pneumoniae infection in childhood [15, 17, 24, 34, 35]. The association between ocular myasthenia gravis and M. pneumoniae infection has not been described before. The pathogenesis of central nervous system involvement remains unknown and, in the majority of cases with neurological disorder, the diagnosis is established on the basis of findings of serological tests and chest roentgeno- gram findings. Case 1 A previously healthy 10-year-old female was admitted to our hospital with a ten-day history of coughing and a two day history of headache, vomiting, and lethargy. Two weeks ago, she was diagnosed to have pneumonia and was given intramuscular ceftriaxone by her family physician. On admission, she was lethargic, but her vital signs regarding heart and respiratory rate and blood pressure were normal. There were bilateral diffuse crackles in auscultation of the lungs. Pupils were reactive to light with equal sizes and there was no papilledema. Deep-tendon reflexes were symmetrically exaggerated and Babinski sign was bilater- ally positive. Neck stiffness and Kernig’s sign were positive. The remainder of the physical and neurological examination was normal. Eur J Pediatr (2008) 167:973–978 DOI 10.1007/s00431-008-0714-1 U. Yiş (*) : S. H. Kurul : E. Dirik Department of Pediatrics, Division of Child Neurology, Dokuz Eylül University School of Medicine, 35340 İzmir, Turkey e-mail: ulyis@yahoo.com H. Çakmakçı Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey