Background: Mycoplasma pneumoniae (Mp) central nervous system complications are reported to be
the most common extrapulmonary manifestations occuring in 0.01–4.8% of Mp infected
patients.
Case: 9 1/12 year old girl with recurrent isolated unilateral left oculomotorius palsy
associated with Mp infection. She bewailed “crossed eyes“ associated with a 2-day
history of frontal headache with mild pain in the left eye. Rhinorrhea and cought
during the proceeding 2 weeks. The examination excluded meningitis, trauma and neoplasia.
High Mp-IgM and -IgG was detectable although CSF PCR for Mp was negative. Despite
extensive viral and bacterial investigation, no evidence of any other pathogen was
found. Initial MRI shows isolated granulomalike inflammation of the left oculomotorius
nerve with brainstem affection. Under antibiotic therapy with clarithromycine for
5 days there was complete remission. Follow up MRI 6 weeks later showed regression
of the initial pathological findings. No other lesions were demonstrable. No serological
signs of remaining infection with Mp. 3 years ago the patient showed similar symptoms
at the left oculomotorius nerve (MRI), high Mp IgM titers, convalescent fall in the
titer and clinical restitution under macrolid therapy.
Results: The pecularity of this case is the recurring affection of left oculomotorius nerve
linked to an acute infection with Mp. The pathologic mechanism remains unclear but
is thought to be the result of direct invasion of the central nervous system or a
postinfectious immune response. Mp serology from blood and CSF should be performed
early in cases where Mp infection is suspected because increased awareness of this
disease entity may facilitate early diagnosis and thereby expedite starting appropriate
therapy that may modify the outcome. We propose that these case report represents
an example of post-Mp immune mediated central nervous system affection and it seems
to be the first report of recurring Mp associated isolated cranial nerve (III) palsy.
