European Journal of Pediatrics

, Volume 151, Issue 6, pp 435–437 | Cite as

Cold haemagglutinin disease complicatingMycoplasma pneumoniae infection in a child under cytotoxic cancer treatment

  • F. M. Fink
  • K. Dengg
  • S. Kilga-Nogler
  • D. Schönitzer
  • H. Berger


Acute cold haemagglutinin disease, most commonly associated with underlying mycoplasma infection, is rare in children. A 3-year-old girl who developed this auto-immune disease under intensive cytotoxic treatment for rhabdomyosarcoma is presented. Clinically, a livedo reticularis skin pattern upon exposure to cold which was reversible at room temperature and a spontaneous red cell agglutination of blood samples in vitro led to the diagnosis. Together with bronchopneumonia the girl developed hyper-IgM, high antibody titres againstMycoplasma pneumoniae, as well as high titres of cold agglutinins. Laboratory signs of mild intravascular haemolysis were found. Positive direct antiglobulin test resulted from coating of red cells with C3d and C4. Three different antibodies were identified in serum: nonspecific cold agglutinins without complement activation, anti-I specific cold agglutinins with complement activation, as well as a weak biphasic Donath-Landsteiner haemolysin. Under antibiotic treatment and a short course of predisolone the clinical course was mild.

Key words

Cold agglutinin disease Auto-immune haemolytic anaemia Childhood cancer Immunosuppression Mycoplasma pneumoniae 



direct antiglobulin test




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  1. 1.
    Buchanan GR, Boxer LA, Nathan DG (1976) The acute and transient nature of idiopathic immune hemolytic anemia in childhood. J Pediatr 88:780–783Google Scholar
  2. 2.
    Cherry JD (1987) Mycoplasma and ureaplasma infections. In: Feigin RD, Cherry JD (eds) Textbood of pediatric infectious diseases, 2nd edn, vol II, WB Saunders, Philadelphia, pp 1896–1924Google Scholar
  3. 3.
    Dearth JC, Rhodes KH (1980) Infectious mononucleosis complicated by severe Mycoplasma pneumoniae infection. Am J Dis Child 134:744–746Google Scholar
  4. 4.
    Foy HM, Ochs H, Davis SD, et al (1973) Mycoplasma pneumoniae infections in patients with immunodeficiency syndromes: report of four cases. J Infect Dis 127:388–393Google Scholar
  5. 5.
    Frappaz D, Rigal D, Valla JS, et al (1983) Thromboses vasculaires multiples au cours d'une anemie hemolytique autoimmune aigue et grave a Mycoplasma pneumoniae traites par echanges plasmatiques et immunosuppresseurs. Pediatrie 38(6):411–419Google Scholar
  6. 6.
    Habibi B, Homberg JC, Schaison G, Salmon C (1974) Autoimmune hemolytic anemia in children. A review of 80 cases. Am J Med 56:61–69Google Scholar
  7. 7.
    Heisel MA, Ortega JA (1983) Factors influencing prognosis in childhood autoimmune hemolytic anemia. Am J Pediatr Hematol Oncol 5(2):147–152Google Scholar
  8. 8.
    Lindström FD, Stahl-Furenhed B (1981) Autoimmune haemolytic anemia complicating Mycoplasma pneumoniae infection. A case report. Scand J Infect Dis 13:233–235Google Scholar
  9. 9.
    Louie EK, Ault KA, Smith BR, et al (1985) IgG-mediated haemolysis masquerading as cold agglutinin-induced anaemia complicating severe infection with Mycoplasma pneumoniae. Scand J Haematol 35:264–269Google Scholar
  10. 10.
    Roberts-Thomson IC, Cottew GS, Fraser JRE (1973) Mycoplasma pneumonia with severe hemolytic anemia. Med J Aust 2:1046–1047Google Scholar
  11. 11.
    Schreiber AD, Gill FM (1987) Autoimmune hemolytic anemia, In: Nathan DG, Oski FA (eds) Hematology of infancy and childhood, 3rd edn. WB Saunders, Philadelphia, pp 413–426Google Scholar
  12. 12.
    Treuner J, Kaatsch P, Anger Y, et al (1986) Ergebnisse der Behandlung von Rhabdomyosarkomen bei Kindern. Ein Bericht der Cooperativen Weichteilsarkomstudie (CWS-81) der Gesellschaft für Pädiatrische Onkologie. Klin Pädiatr 198:208–217Google Scholar
  13. 13.
    Widmann F (ed) (1985) Technical Manual, 9th edn, American Association of Blood Banks, ArlingtonGoogle Scholar
  14. 14.
    Zupanska B, Lawkowicz W, Gorska B, et al (1976) Autoimmune haemolytic anemia in children. Br J Haematol 34:511–520Google Scholar

Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • F. M. Fink
    • 1
  • K. Dengg
    • 1
  • S. Kilga-Nogler
    • 2
  • D. Schönitzer
    • 2
  • H. Berger
    • 1
  1. 1.Department of PaediatricsUniversity of InnsbruckInnsburkAustria
  2. 2.Blood Transfusion Centre, School of MedicineUniversity of InnsbruckInnsbruckAustria

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