Severe infectious acute respiratory failure mimicking COVID‐19 in a healthy adolescent

A 15‐year‐old male presented with headache, high fever and respiratory distress. Chest computed tomography showed bilateral pneumonia, and antimicrobial therapy was initiated. However, his respiratory condition deteriorated, and he developed respiratory failure requiring intubation. A multiplex polymerase chain reaction (PCR) test and 16S ribosomal RNA gene analysis were done from his intratracheal secretions to determine the causative pathogens, and Mycoplasma pneumoniae was detected. He was treated with appropriate antimicrobial therapy, systemic corticosteroid therapy and extracorporeal membrane oxygenation. He also presented with pulmonary thromboembolism and was treated with anticoagulants, to which he responded well. This patient demonstrates the similarities between severe M. pneumoniae pneumonia with bilateral pneumonitis and thrombosis, and severe coronavirus disease 2019. Therefore, it is important to identify cases of bilateral pneumonia with severe respiratory dysfunction using multiplex PCR tests to provide appropriate medical management and therapeutic interventions. We report a patient with severe Mycoplasma pneumoniae mimicking severe coronavirus disease 2019, characterized by rapid‐onset respiratory dysfunction and pulmonary embolism.

Severe infectious acute respiratory failure mimicking COVID-19 in a healthy adolescent.

A 15-year-old male presented with headache, high fever and respiratory distress. Chest computed tomography showed bilateral pneumonia, and antimicrobial therapy was initiated. However, his respiratory condition deteriorated, and he developed respiratory failure requiring intubation. A multiplex polymerase chain reaction (PCR) test and 16S ribosomal RNA gene analysis were done from his intratracheal secretions to determine the causative pathogens, and Mycoplasma pneumoniae was detected. He was treated with appropriate antimicrobial therapy, systemic corticosteroid therapy and extracorporeal membrane oxygenation. He also presented with pulmonary thromboembolism and was treated with anticoagulants, to which he responded well. This patient demonstrates the similarities between severe M. pneumoniae pneumonia with bilateral pneumonitis and thrombosis, and severe coronavirus disease 2019. Therefore, it is important to identify cases of bilateral pneumonia with severe respiratory dysfunction using multiplex PCR tests to provide appropriate medical management and therapeutic interventions.

Pulmonary histoplasmosis diagnosed in a Japanese woman after traveling to central and South America: A case report.

Histoplasmosis is a fungal infection caused by Histoplasma capsulatum, and Japan is considered a non-endemic area for histoplasmosis. Most patients diagnosed with histoplasmosis in the past usually have exposure to caves and bat guano with travel history to endemic areas. Therefore, travel history and risk activities should be comprehensively assessed when suspecting histoplasmosis because this important information may be overlooked. Although few, possibilities of indigenous cases have also been suggested. Moreover, it is assumed that the number of travelers and endemic mycoses has decreased with the recent coronavirus disease 2019 epidemic. However, clinicians should carefully consider the differential diagnosis of histoplasmosis for travelers traveling to endemic areas. In this case report, we describe an immunocompetent Japanese woman who developed histoplasmosis due to a history of travel to an endemic country. Our case report suggests that clinicians should not exclude histoplasmosis from the differential diagnosis even in the absence of risk features such as activities or immunodeficiencies during travel.