American Journal of Hematology 75:413–414 (2004)

Images in Hematology

Peripheral Blood Mitosis in Association With

Mycoplasma pneumoniae Infection
Francisca Ferrer,1* Margarita Cámara,2 and Francisco Ortuño3
1
Hematology Unit, Hospital Los Arcos, Santiago de la Ribera, Murcia, Spain
2
Microbiology Unit, Hospital Los Arcos, Santiago de la Ribera, Murcia, Spain
3
Hematology and Medical Oncology Unit, School of Medicine, Hospital Morales Meseguer, Murcia, Spain

Image 1. Image 2.

Mitotic figures of mononuclear cells are rarely seen
in the peripheral blood. To date, Epstein-Barr virus
(EBV) is the only infectious setting in which this phe-
nomenon has been observed. We recently observed
mitotic figures on the blood films of two children with
what appeared to be Mycoplasma pneumoniae infec-
tion. These two cases are described here.
CASE #1
A 13-year-old girl presented with a 10-day history of
fever, cough, and rhinorrhea. Physical examination
revealed rales in the right chest posteriorly. Her labora-
tory results included a total white blood count of 18.3 
109/L, a hemoglobin level of 11.9 g/dL, and a platelet
count of 456  109/L. Both the ALT and AST were
increased, as were the sedimentation rate and the level of
C-reactive protein. Her chest X-ray showed an infiltrate
in the right upper lung. The peripheral blood film
revealed 74% neutrophils. In addition, a mononuclear
cell mitosis was seen (see Image 1). Antibody (IgM) for
M. pneumoniae was positive. All other serological
ª 2004 Wiley-Liss, Inc.
studies, including anti-EBV, were negative. The patient
was placed on clarithromycin, following which she
promptly defervesced and was able to be discharged
for outpatient followup.
CASE #2
An 18-month-old female was admitted to the hos-
pital because of cough, rhinorrhea, and fever. Shortly
before admission, the child’s father and brother were
both found to have ‘‘atypical’’ pneumonia for which
they were each given a 10-day course of clarithro-
mycin. The physical examination of the young child
revealed fever, cervical lymphadenopathy, and hepa-
tosplenomegaly. Her laboratory findings included a
*Correspondence to: Francisca Ferrer Marı́n, M.D., Ph.D., Unit of
Haematology, Hospital Los Arcos, Paseo de Colón, 54, 30720 San-
tiago de la Ribera, Murcia, Spain. E-mail: francisca.ferrer@carm.es
Received for publication 24 June 2003; Accepted 15 August 2003
Published online in Wiley InterScience (www.interscience.wiley.com).
DOI: 10.1002/ajh.10469
414 Images in Hematology: Ferrer et al.
total white blood count of 28.5  109/L; a hemoglobin
level of 10.1 g/dL; and ALT and AST levels of 106
and 154 U/L, respectively. Her chest X ray revealed
no infiltrates. The peripheral blood film prepared
with the May–Grünwald–Giemsa stain showed 79%
lymphocytes, many of which were thought to be
‘‘activated.’’ Also, numerous leukocytes appeared to
be apoptotic, and mitosis of a mononuclear cell was
seen (see Image 2). Serological studies revealed IgM
antibodies for both M. pneumoniae and EBV (VCA).
Over the following 10 days, the patient made an
uneventful recovery.
The observation of mononuclear cell mitosis in the
peripheral blood is an extremely unusual finding. To
date, EBV has been the only infectious agent with
which this phenomenon has been reported previously.
However, the two cases described here, especially
Case #1, suggest that mononuclear cell mitoses in
the peripheral blood may also appear in association
with M. pneumoniae infection.