Very atypical pneumonia in a two-year-old patient

Childhood community-acquired pneumonia is an important cause of morbidity and mortality in children. Most of them are solved on an outpatient setting, without an etiological diagnosis. Age is the parameter that best correlates with the etiology, however, up to 20-30% of cases is due to a mixed infection by different germs. Most frequently coinfections by viruses and bacteria are described, especially respiratory syncytial virus with Streptococcus pneumoniae and Mycoplasma pneumoniae. However, the association of three or more pathogens is exceptional. The role of this co-pathogenicity is unknown about prognosis and evolution and cannot be specified if agents are concomitant over time or developmental aggravating factors. We present the case of a girl with pneumonia by Mycoplasma pneumoniae who presents symptoms and radiography similar to Streptococcus pneumoniae infection and also positive serology testing IgM for Epstein-Barr virus and parvovirus B19.