Beyond the Lungs: Rising Pediatric Mycoplasma pneumoniae Infections with Extrapulmonary Manifestations in the Post-COVID-19 Pandemic Era.

BACKGROUND

Following the relaxation of COVID‑19 mitigation strategies, Mycoplasma pneumoniae (MP) infections have resurged worldwide. Although respiratory involvement predominates, extrapulmonary manifestations in children are increasingly recognized. We aim to report a recent rise in pediatric MP infections with notable extrapulmonary features, including rash, mucositis, acute myocarditis, and other parainfectious eruptions.

METHODS

We describe 6 pediatric cases with extrapulmonary MP manifestations admitted to our center from March 2025 to October 2025. The diagnosis was confirmed through serology or PCR testing. We reviewed the clinical features, laboratory results, and treatment outcomes.

RESULTS

Five patients exhibited generalized targetoid rashes, often accompanied by fever, conjunctival hyperemia, or mucosal changes. The median age 14 years (min: 13 months -max: 17.5 years), and 3 patients were female. Several were initially misdiagnosed as meningococcemia, Kawasaki disease, or MIS‑C. One adolescent developed MP‑associated acute myocarditis, with hypotension, elevated cardiac markers, and mild cardiomegaly. Another patient presented with reactive infectious mucocutaneous eruption (RIME) limited to oral lesions. All patients received macrolide therapy (clarithromycin or azithromycin), with rapid clinical improvement, resolution of lesions, normalization of cardiac markers, and no major adverse effects.

CONCLUSIONS

MP infection in children may present with dermatologic, mucocutaneous, or cardiac involvement even in the absence of respiratory symptoms. Clinical awareness beyond respiratory findings is crucial to avoid misdiagnosis and inappropriate treatment. Broader diagnostic and surveillance approaches are needed to improve recognition, especially in the context of evolving post‑pandemic host and pathogen dynamics.