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Mycoplasma pneumoniae has been recognized as a trigger for extrapulmonary neurologic complications. Among the most common neurologic sequelae, transverse myelitis came second to encephalitis in children. Acute transverse myelitis (ATM) is a rare demyelinating disorder caused by inflammation of the spinal cord most often as a result of an abnormal immune response post-infection. While several pediatric cases have connected M. pneumoniae with ATM, we could not identify any previously reported cases of familial clustering in the literature.

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Case Presentation: 

Two previously healthy and developmentally appropriate sisters, ages 7 and 5, presented within two weeks of each other with neurological symptoms following pneumonia. Both initially had acute ataxia, headache, and other features of acute post-infectious cerebellitis versus meningitis. 

They initially improved without any pharmacological interventions, but within weeks, the older sister returned with worsening symptoms. A spine MRI was obtained and confirmed ATM. Upon lab work, both sisters had elevated M. pneumoniae IgM titers and elevated ESR while CSF PCR for M. pneumoniae was negative for the older sister. The older sister received escalating immunomodulatory therapy including intravenous methylprednisolone, intravenous immunoglobulin (IVIG), and doxycycline before achieving full recovery. The younger sister recovered with the exception of a mild gait abnormality after treatment with doxycycline and supportive care.

The patients' family history was significant for autoimmune disorders in both grandmothers, including Sjögren syndrome and psoriatic arthritis.

Genetic and immunologic factors may predispose patients to post-infectious neurological complications. To our knowledge, these cases represent the first reported familial occurrence of M. pneumoniae-associated neurological complications. In addition, they underline the importance of considering M. pneumoniae in the setting of pediatric ATM, particularly when similar clinical features occur within the same family.