# Double Agglutination Observed in Mycoplasma-Associated Kawasaki Disease: Pathophysiological Insights and Considerations for Treatment Strategy

## TL;DR

A rare case of Kawasaki disease linked to Mycoplasma infection shows both red blood cell and neutrophil agglutination, offering insights into diagnosis and treatment.

## Contribution

This case highlights the rare occurrence of neutrophil agglutination in Mycoplasma-associated Kawasaki disease and its diagnostic challenges.

## Key findings

- Neutrophil agglutination resolved within a week, while erythrocyte agglutination lasted four weeks.
- Erythrocyte agglutination may help diagnose Mycoplasma infection, but neutrophil agglutination is rare and challenging to detect in children.

## Abstract

We describe a rare pediatric case of Mycoplasma-associated Kawasaki disease, accompanied by secondary cold agglutinin disease, characterized by both erythrocyte and neutrophil agglutination. In this case, neutrophil agglutination resolved within one week, while erythrocyte agglutination persisted for four weeks, paralleling the decline in Mycoplasma antibody titers and suggesting possible differences in their agglutination thresholds. Erythrocyte agglutination through secondary cold agglutinin disease sometimes facilitates the concomitant diagnosis of Mycoplasma infection. On the other hand, neutrophil agglutination is rare, particularly in children, which poses a diagnostic challenge. This case also highlights potential diagnostic considerations and management challenges when Kawasaki disease occurs in the setting of Mycoplasma infection. A brief discussion of clinical implications and a review of relevant literature are provided.