Objective

To investigate the clinical characteristics，diagnosis，treatment and prognosis of children with Mycoplasmapneumoniae encephalitis（MPE）complicated with binocular diplopia.

Methods

A child （patient 1）diagnosed with MPE and experiencing binocular diplopia was admitted to Dingxi Hospital of Traditional Chinese Medicine in November 2023，was selected as the subject of this research.A retrospective analysis was conducted to evaluate the clinical data of patient 1，and relevant studies on children with MPE were reviewed from both domestic and international databases to summarize the clinical characteristics，diagnosis，treatment and prognosis of the disease.The procedures followed in this study adhered to the WorldMedicalAssociationDeclarationof Helsinki revised in 2013.The guardian provided informed consent for the diagnosis and treatment of patient 1.

Results

①Patient 1，male，9 years old，developed with fever，headache，dizziness，and binocular diplopia，without other manifestations of nervous system involvement.The serum Mycoplasmapneumoniae（MP）-Ig M antibody was positive.Cerebrospinal fluid examination showed that cerebral pressure was normal，with colorless，water-like liquid，clear and transparent，mucin was qualitatively negative.Biochemical analysis of cerebrospinal fluid showed that glucose level was normal，lactate dehydrogenase and chlorine levels were decreased；Bacterial culture in cerebrospinal fluid was negative.After 5 days of treatment with azithromycin for anti-infection and MPE，the above symptoms of patient 1 were quickly relieved and cured，and was discharged from hospital for 5 days hospitalization.The discharge diagnosis was MPE.There were no recurrence and no neurological sequelae during follow up of 2 months after discharge.②Literature review results：there were 241 children with MPE in 11 MPE related studies and plus patient 1，the clinical data of 242 children with MPE were analyzed as follows.Among the 242 children with MPE，fever （73.9%），headache（72.3%），disturbance of consciousness （47.9%）were the main clinical manifestations，and most of the meningeal irritation signs （46.7%）and pathological signs （21.4%）were positive.In auxiliary examinations，the higher positive rates were electroencephalogram （77.3%），serum MP-Ig M positive（73.1%），and increased white blood cell count in cerebrospinal fluid （41.7%），respectively.Moreover，more children with MPE have pneumonia，but hallucinations，auditory hallucinations，and visual hallucinations were rare.MPE with binocular diplopia has not been reported yet.All 242 children were treated with macrolides，and severe children were treated with methylprednisolone sodium succinate or gamma globulin.Most children with MPE diagnosed and treated early had a good prognosis.

Conclusion

Binocular diplopia can occur in children with MPE，which has certain reference for early diagnosis and treatment of children with MPE.