Clinical Characteristics, Treatment and Long-Term Prognosis of Mycoplasma pneumoniae-Associated Necrotizing Laryngotracheobronchitis in Children: A Report of Four Cases and Literature Review
TL;DR
Bronchoscopy combined with pathogenic detection and targeted next-generation sequencing and tNGS constitutes the cornerstone of diagnosis and should be strongly suspected in pediatric patients with M. pneumoniae infection who present with hoarseness, tachypnea, or dyspnea that cannot be fully explained by chest imaging findings.
Abstract
Background Necrotizing laryngotracheobronchitis (NLTB) is a rare and life-threatening airway disease characterized by mucosal necrosis, ulceration and pseudomembrane formation. Mycoplasma pneumoniae-associated NLTB remains exceedingly rare in children, with merely sporadic cases reported globally. Methods Four previously healthy children hospitalized with M. pneumoniae-associated NLTB from January 2023 to June 2025 were enrolled retrospectively. We systematically analyzed clinical features, etiological findings, therapeutic regimens and follow-up outcomes of these cases, and reviewed relevant literature. Results The main clinical manifestations included fever, cough, hoarseness, tachypnea and dyspnea. Bronchoscopy confirmed the diagnosis of NLTB. Notably, most patients presented with disproportionately severe airway symptoms compared with radiological lesions. Combined etiological tests and targeted next-generation sequencing (tNGS) confirmed mixed infections in three cases. All children received macrolides or doxycycline plus glucocorticoids, and most underwent repeated bronchoscopic procedures. All achieved clinical remission and were discharged uneventfully. During follow-up, one patient developed tracheal granulation tissue hyperplasia, and the other developed bronchitis obliterans. Conclusion M. pneumoniae-associated NLTB should be strongly suspected in pediatric patients with M. pneumoniae infection who present with hoarseness, tachypnea, or dyspnea that cannot be fully explained by chest imaging findings. Bronchoscopy combined with pathogenic detection and tNGS constitutes the cornerstone of diagnosis. Standardized multimodal therapy, including antimicrobials, anti-inflammatory agents, and endoscopic intervention, improves short-term clinical outcomes. Long-term follow-up is indispensable for identifying and managing delayed airway sequelae.