Acute liver failure and secondary TMA-like phenomenon following SARS-CoV-2 and Mycoplasma pneumoniae co-detection in a child: a case report - Report - MDSpire

Acute liver failure and secondary TMA-like phenomenon following SARS-CoV-2 and Mycoplasma pneumoniae co-detection in a child: a case report

  • By

  • Qian Liu

  • Ting Kang

  • Wenjuan Zeng

  • Yuan Long

  • May 28, 2026

  • 0 min

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Acute liver failure and a TMA-like condition in a child with concurrent SARS-CoV-2 and Mycoplasma pneumoniae infection: a case study

Overview

This report details a case of a 20-month-old girl who developed acute liver failure and a secondary thrombotic microangiopathy-like condition following co-infection with SARS-CoV-2 and Mycoplasma pneumoniae.

Background

The co-detection of SARS-CoV-2 and Mycoplasma pneumoniae in children is increasingly recognized, yet the clinical implications remain poorly characterized. Severe infections can lead to complications such as acute liver failure and thrombotic microangiopathy.

Data Highlights

ParameterValue
ALT17,134 U/L
Ferritin10,929.6 ng/mL
IL-674 pg/ml
Thrombocytopenia52 × 109/L
Creatinine181.5 μmol/L

Key Findings

  • The patient presented with acute liver failure and extreme hyperinflammation.
  • Co-detection of SARS-CoV-2 and Mycoplasma pneumoniae was confirmed through microbiological workup.
  • Initial improvement in liver function was observed with glucocorticoid therapy.
  • A secondary TMA-like phenomenon developed, characterized by severe thrombocytopenia and acute kidney injury.
  • Negative complement gene testing supported the diagnosis of severe infection-associated secondary TMA.

Clinical Implications

Monitoring for secondary TMA-like phenomena in pediatric patients with severe hyperinflammation and concurrent viral and bacterial infections is important.

Conclusion

This case describes a clinical sequence from acute liver failure to a secondary TMA-like phenomenon associated with SARS-CoV-2 and Mycoplasma pneumoniae co-detection.

Related Resources & Content

  1. Bone Marrow Transplantation, Nature, 2020 -- COVID-19 in Pediatric Patients Following Hematopoietic Stem Cell Transplantation: A Case Study of Two Individuals
  2. Infection, Springer, 2020 -- Pulmonary Mucormycosis as a Complication Post-SARS-CoV-2 Infection: A Case Report
  3. Infection, Springer, 2021 -- Surprising Co-Infections Acquired in the Community During a Continuing Pandemic: An Overabundance of Concurrent Diagnoses
  4. Management of Acute Liver Failure | AASLD
  5. Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations - PMC
  6. Infection — Co-infection of SARS-CoV-2 with Chlamydia and Mycoplasma pneumoniae: A Case Series and Literature Review
  7. Management of Acute Liver Failure | AASLD
  8. Intravenous N-acetylcysteine in Pediatric Patients with Non-Acetaminophen Acute Liver Failure: A Placebo-Controlled Clinical Trial - PMC
  9. No Significant Beneficial Effects of Intravenous N-Acetylcysteine on Patient Outcome in Non-Paracetamol Acute Liver Failure: A Meta-Analysis of Randomized Controlled Trials
  10. Preliminary experience of combined dual plasma molecular adsorption system and plasma exchange in pediatric acute liver failure: a retrospective case series | BMC Pediatrics | Full Text
  11. Evidence of thrombotic microangiopathy in children with SARS-CoV-2 across the spectrum of clinical presentations - PMC
  12. COVID-19 Microangiopathy: Insights into plasma exchange as a therapeutic strategy - PubMed
  13. Ten tips for managing complement-mediated thrombotic microangiopathies (formerly atypical hemolytic uremic syndrome): narrative review | BMC Nephrology | Full Text
  14. Multidisciplinary consensus on the diagnosis and management of patients with atypical Hemolytic Uremic Syndrome (complement-mediated TMA): Recommendations from Italian scientific societies, patient associations and regulators - PubMed
  15. Advancements in Complement Inhibition for PNH and Primary Complement Mediated Thrombotic Microangiopathy | Blood Advances | American Society of Hematology
  16. Co-detection of various viruses in SARS-CoV-2 in children with respiratory infections | Scientific Reports
  17. Analysis of the characteristics of mixed infections with Mycoplasma pneumoniae in children | Scientific Reports
  18. Immune responses in children with secondary infection of mycoplasma pneumoniae after COVID-19: focus on eosinophils and IgE | BMC Infectious Diseases | Full Text
  19. More than Mucositis: Pediatric RIME Following Co-Infection with SARS-CoV-2 and Mycoplasma pneumoniae—A Case Report and Mini-Review | MDPI
  20. Pulmonary thromboembolism due to Mycoplasma pneumoniae in children: a case report and literature review | BMC Pediatrics | Full Text
  21. Clinical characteristics and risk factors of pulmonary embolism with Mycoplasma pneumoniae pneumonia in children | Scientific Reports

Original Source(s)

Acute liver failure and secondary TMA-like phenomenon following SARS-CoV-2 and Mycoplasma pneumoniae co-detection in a child: a case report

  • by Qian Liu, Ting Kang, Wenjuan Zeng, Yuan Long

  • May 28, 2026

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