Mycoplasma pneumonia infection has been associated with various neurological disorders affecting both the central and peripheral nervous systems. However, the potential link between mycoplasma infection and autoimmune-triggered demyelination remains underexplored. We present a rare case of spinal cord demyelination following a mycoplasma infection in an otherwise healthy individual, with extensive workup revealing no other demyelinating disorders.

A 38-year-old female with a history of Graves’ disease presented with three day history of generalized weakness, inability to walk or move her upper and lower extremities. This onset followed her recent treatment for mycoplasma pneumonia treated with azithromycin three days prior. Upon examination, she exhibited flaccid weakness, with motor strength 3/5 in the right upper and lower extremities and 1/5 in the left side. Sensation remained intact across all four extremities, negative Hoffman’s, and Babinski signs, with 1-2 beats of bilateral ankle clonus. Initial laboratory tests revealed an elevated ESR of 78. Cerebrospinal fluid (CSF) analysis showed 43 WBCs with lymphocytic predominance, glucose at 87, and protein at 53. Notably, CSF mycoplasma IgM was significantly elevated at 110, and IgG level 3.3. EBV IgG was positive, and four oligoclonal bands were present. Extensive autoimmune and vasculitis workup returned negative, including tests for MOG and NMO/aquaporin-4 antibodies twice. MRI scans revealed bilateral T2/FLAIR hyperintense foci in the pons and medulla, along with multiple centrally located T2 enhancing lesions in the cervical and thoracic spinal cord from C2 to T7. The patient was treated with intravenous methylprednisolone (1 gram for 5 days), resulting in significant improvement in motor strength, and she was subsequently discharged to rehabilitation.

A rare case of brain and spinal cord demyelination presenting with Quadraparesis following mycoplasma infection. This emphasizes the need for future studies to identify the factors that can trigger autoimmunity and demyelination associated with such infections.