This report entails a case of refractory pneumonia with a wild variety of extra-pulmonary manifestations due to macrolide-resistant Mycoplasma pneumoniae infection in a 7-year-old boy. The diagnosis was based on isolating M. pneumoniae through cultivation from the patient's bronchial aspirations at admission and the following susceptibility testing. Initial treatments consisting of a combination of azithromycin and standard-dosed methylprednisone (2mg/kg) were completely nonresponsive and the patient's condition deteriorated rapidly. However, methylprednisone pulse therapy (20mg/kg for 3 days, tapering within 1 month) and intravenous immunoglobulin (1g/kg/day, two doses), in addition to moxifloxacin (10mg/kg for 7 days) were remarkably effective and led to a favorable outcome without any observed side effects during inpatient hospitalization and outpatient follow-up. Pediatr Pulmonol. 2013; 48:519522. (c) 2012 Wiley Periodicals, Inc.