Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus responsible for the outbreak of respiratory illness known as coronavirus disease 2019 (CoVID-19). Mycoplasma is an uncommon co-infected pathogen with SARS-CoV-2 and has not yet been reported. Computed tomography (CT), used as an accessory examination, may play a more significant role in this co-infection.

A 49-year-old female presented with a cough, expectoration and chest congestion followed by elevated C-reactive protein and erythrocyte sedimentation rate. CT images showed ground-glass opacities in bilateral lower lobes and a patchy and striate shadow in the right upper lobe. Immunoglobulin M antibody of Mycoplasma pneumoniae was positive and real-time fluorescence polymerase chain reaction of sputum was positive for SARS-CoV-2 nucleic acid. The diagnosis of CoVID-19 was made based on laboratory results, chest CT images, clinical manifestations and epidemiologic characteristics. She was treated with combination therapy for 17 d and showed a marked reCoVery.

Co-infection with SARS-CoV-2 and Mycoplasma in CoVID-19 patients appears to be uncommon. CT is an acceptable method for the primary diagnosis and treatment should be initiated as soon as possible. Combination therapy with antiviral, anti-inflammatory, traditional Chinese herbal medicine and interferon inhalation may be a reference for further progress in treating this co-infection.

Coronavirus disease 2019 (CoVID-19) is a respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which has already infected over 70000 and killed more than 2000, especially in Wuhan, China. A study of 8274 samples showed that 5.8% of CoVID-19 infected and 18.4% of non-CoVID-19-infected patients had other infections[1]. However, co-infection with SARS-CoV-2 and Mycoplasma has not been reported previously. We report the case of a 49-year-old female co-infected with SARS-CoV-2 and Mycoplasma.

CoVID-19 and Mycoplasma infection.

According to Chinese newest treatment guidelines for SARS-CoV-2, the patient was treated with antiviral drugs (Aluvia, Peramivir, Interferon-α2b), anti-inflammatory drugs (Cefonicid Sodium, Azithromycin, Moxifloxacin) and traditional Chinese herbal medicine (Lianhuaqingwen), combined with supportive care and interferon inhalation from January 25, 2020 and she was discharged on February 10, 2020.

On the 7^th day, her cough, expectoration, chest congestion and debilitation started to improve. Laboratory tests of SARS-CoV-2 nucleic acid, lymphocyte count, erythrocyte sedimentation rate, potassium, total calcium, lactate dehydrogenase, blood oxygen saturation and IgM antibody of Mycoplasma pneumoniae all showed that the patient had improved. A marked reCoVery was noted in this patient at the 2 wk follow-up.

The outbreak of CoVID-19 caused by SARS-CoV-2 has resulted in significant harm to human health globally, and has been declared a public health emergency of international concern by the WHO[2].

CoVID-19 has spread in 43 countries, including South Korea, Japan, Italy, and the United States. Person-to-person transmission in hospital and family settings has been identified and more than 2600 lives have been lost. From up-to-date data, it can seen that fever and cough are the most common symptoms, and both diarrhea and vomiting are rare. Most patients have lymphopenia and elevated levels of C-reactive protein on admission[3]. Among 2745 CoVID-19 patients, 104 were positive for multiple respiratory pathogens and 6/104 had co-infection with coronavirus (3/104), influenza A virus (2/104), rhinovirus (2/104), and influenza A H3N2 (1/104)[1]. Co-infection with SARS-CoV-2 and Mycoplasma is unusual and has not been reported previously. Treatment protocols and prognosis are new with few references.

Imaging studies have shown that ground-glass opacity and bilateral patchy shadowing are the most common features on chest CT[3-5]. In our patient, progressive changes in typical CT manifestations were seen in bilateral lower lobes which were thought to be caused by CoVID-19, but an untypical isolated shadow in the upper right lung was also seen. This was thought to be caused by Mycoplasma infection.

In conclusion, co-infection with SARS-CoV-2 and Mycoplasma should not be ignored in clinical diagnosis and treatment, especially in the early course as CoVID-19 is a rapidly developing disease. CT manifestations may be a better and quicker route to the diagnosis of CoVID-19 than nucleic acid testing using RT-PCR, and can result in timely treatment. Clinical improvement in CT images in our patient suggested that our novel combination therapy may be a reference for further progress in the treatment of this co-infection. As these pathogens are very infectious, doctors and nurses, particularly those on the first line, require personal protective equipment.