Mycoplasma pneumoniae is a common pathogen of community-acquired pneumonia, and its pathogenesis mainly includes three aspects. Mycoplasma pneumoniae attaches to ciliated cells of the respiratory epithelium and then produces oxidative stress. It also releases the CARDS toxin, leading to airway damage. Through immunomodulation of the host immune response it enables establishment of persistent infections and causes autoimmune phenomena. My-coplasma pneumoniae can also lead to multiple organs damage, which pathogenic mechanism is not yet clear. Many clinical manifestations of acute infection as well as extrapulmonary complications are due to immunopathologic and in-flmmatory effects produced by the host, with or without blood clotting. This paper systematically reviewed the results of the current Mycoplasma pneumoniae pathogenic mechanisms.