Zheng B, et al. - Since the incidence of necrotizing pneumonia (NP) caused by Mycoplasma pneumoniae (MP) is increasing, researchers performed this retrospective observational study to analyze the clinical features and the risk factors for NP caused by MP. This investigation was carried out in 37 patients with NP caused by MP (NP group) and 74 patients diagnosed with lobar M. pneumoniae pneumonia without necrosis (control group) who were admitted to the hospital between January 2013 and December 2017. In the NP group, the proportion of females, the incidence of pleural effusion, duration of fever, days of hospitalization, white blood cell count, neutrophil ratio, D-dimer level and use of other types of antibiotics were higher than in the control group. According to results, NP is a rare complication of severe Mycoplasma pneumoniae pneumonia (SMPP), and the necrotic area is gradually absorbed while the clinical course is longer than common MP infection. A white blood cell count > 12.3 × 10⁹/L, a neutrophil ratio > 73.9% and D-dimer level > 1367.5 ng/mL are risk factors for pulmonary necrosis in patients with SMPP with lobar consolidation, and the use of low molecular weight heparin decreases the risk of pulmonary necrosis.