Abstract
Mycoplasma pneumoniae (MP) is a common pediatric respiratory pathogen that can rarely present with extrapulmonary manifestations such as hepatic involvement. Recognition of hepatic dysfunction in this context is important for accurate diagnosis and timely therapy. A five-year-old female with asthma presented with fever, cough, fatigue, pruritus, and scleral icterus. Laboratory evaluation revealed leukocytosis, elevated C-reactive protein, mild transaminitis, direct hyperbilirubinemia, elevated PT/PTT, and normocytic anemia. Infectious and hepatic workups were initially unrevealing. The patient showed gradual clinical improvement while receiving empiric ceftriaxone but had persistent leukocytosis. On hospital Day 7, a positive MP IgM prompted azithromycin initiation, which corresponded to the normalization of hepatic indices. This case highlights a rare extrapulmonary manifestation of MP infection with mild hepatic dysfunction and transient hematologic changes, emphasizing the importance of recognizing atypical presentations of MP to facilitate timely diagnosis, avoid unnecessary interventions, and prevent prolonged hospitalization.