Objective We reviewed 5 cases to determine the disease course and outcome in pediatric patients with necrotizing pneumonitis resulting from M. pneumoniae infection.

Methods Five patients who were diagnosed and treated in the Department of Pediatrics, Uijeongbu St. Mary’s Hospital from January 2003 to December 2006 were reviewed in this study.

Results One patient was a boy and others were girls. All were less than 5 years of age and had no immunocompromised conditions. Necrotizing pneumonitis was diagnosed on chest CTs and the necrotic foci were identified as multiple low-attenuation changes within consolidation areas. Cavitary necrosis was shown in 3 patients and persisted as pneumatoceles, which disappeared on the follow-up chest radiographs nearly up to 7 months following admission. Macrolide and broad-spectrum antibiotics were administered in all patients and chest tube drainage was performed in 2 patients. Systemic steroid therapy was added in 4 patients. Of those four, 2 patients, both under 2 years of age, improved more rapidly than others in clinical status and radiographic findings. In spite of steroid therapy, one patient died of acute respiratory distress syndrome. Two patients who were under 2 years were normalized and 2 patients who were 4 years of age showed remaining cavitation or fibrosis in the last follow-up chest radiographs.

Conclusions Our results may suggest though they are not yet proven nor have they been discussed extensively that younger patients show better prognoses than older children. Further well-designed and large scale studies may be warranted.