Authors
Yuhang Hu, Jian Chen, Lijuan Wu, Jing Xu, Xuemei Xu, Juan Du, Min Kang, Xianmin Wang
Published in
Frontiers in immunology. Volume 17. Pages 1845246. Epub Sep 30, 2026.
Abstract
Thromboembolism is a critical complication of severe Mycoplasma pneumoniae pneumonia (SMPP) in children, yet its clinical spectrum and immunothrombotic mechanisms remain poorly defined. The "dual-hit" hypothesis-synergy between infection-induced inflammation and transient antiphospholipid antibodies (aPLs)-lacks integrated clinical validation.
We report a case of extensive multi-system thrombosis in a 6-year-old boy with SMPP. A systematic review of literature (January 2020-December 2025) identified 19 studies comprising 199 pediatric cases.
In the index case, thrombosis coincided with hyperinflammation and transient aPLs, which seroconverted to negative upon recovery. Pooled analysis showed multi-system involvement in 27.1% of cases (54/199). Among tested patients (n = 65; 32.7% of the cohort), aPL positivity was 69.2% (45/65). Most patients achieved favorable outcomes with anticoagulation and immunomodulation.
This study is consistent with the "dual-hit" model in SMPP, where systemic inflammation may prime the endothelium and transient aPL positivity coincides with an extensive thrombotic burden. The high prevalence of multi-system involvement supports low-threshold vascular imaging and aPLs screening, along with biomarker-guided management. Transient aPLs should be interpreted as a potential risk-amplifying biomarker rather than a proven causal driver of thrombosis.
PMID:
42876815
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.
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