Mycoplasma pneumoniae–Associated Mucocutaneous Disease in Children: Dilemmas in Classification

Abstract

There is controversy regarding precise definitions for Stevens-Johnson syndrome (SJS) and erythema multiforme (EM) major because of overlap in clinical presentations. SJS and EM major associated with Mycoplasma pneumoniae have been reported to occur in children, but Mycoplasma is more commonly reported with SJS. We sought to further characterize Mycoplasma-associated mucocutaneous disease. Through retrospective chart review over 10 years, six children hospitalized with a diagnosis of SJS who also tested positive for Mycoplasma infection were reviewed. Using documented physical examinations and photographs, diagnoses of SJS or EM major were retrospectively made based upon cutaneous lesional morphology employing the classification system proposed by Bastuji-Garin et al. The majority of patients were boys, with limited acral cutaneous lesions. All patients required prolonged hospitalization because of mucosal involvement and had good short-term outcomes. When the classification system was retrospectively applied, five of the six patients were reclassified with a diagnosis of EM major instead of SJS. Children with Mycoplasma-associated EM major and SJS in our small retrospective series appeared to have significant mucosal involvement but more limited cutaneous involvement with lesional morphology, which is more characteristic of EM major.

Paediatric Erythema Multiforme: Epidemiological, Clinical and Laboratory Characteristics

“…In these cases, EM tends to recur several times (9). Mycoplasma pneumoniae is also a prominent pathogen, which may also be associated with SJS (10,11). Various other aetiologies have been associated with EM (drugs, auto-immune disorders, malignancy, radiation, etc.…”

Mycoplasmen-assoziierte Haut- und Schleimhautveränderungen

“…Hautveränderungen im Rahmen einer Infektion mit Mycoplasma pneumoniae treten häufig bei Kindern und jungen Erwachsenen im Alter zwischen 5 und 35 Jahren auf und werden meist als EM, SJS oder TEN beschrieben [1,2,4]. Während das Stevens-Johnson-Syndrom zumeist Medikamenten-assoziiert beschrieben wird, tritt das Erythema multiforme eher im Rahmen einer Infektionserkrankung auf [7].…”

“…Beim Vollbild des SJS sind neben der Mundschleimhaut bei ¾ der Patienten das Genitale und bei ⅔ der Patienten die Augen betroffen [1]. Der Übergang zur toxischen epidermalen Nekrolyse mit großflächigen Ablösungen der Epidermis ist aufgrund der signifikant erhöhten Morbidität und Mortalität gefürchtet [7].…”

“…Im Gegensatz dazu werden beim Erythema multiforme häufig deutlich mildere Verläufe beschrieben [7]. Das EM ist meistens mit einer Herpes-Simplex-Infektion assoziiert und tritt durch klassische Kokarden im Bereich der Extremitäten in Erscheinung.…”

Wells’ syndrome related to Mycoplasma pneumoniae in a 5‐year‐old boy

“…Dermatological manifestations of M. pneumoniae infection vary widely from a mild erythematous maculopapular rash to severe Stevens–Johnson syndrome. Several pathogenic features of M. pneumoniae infection are attributed to immune‐mediated reactions rather than direct bacteria‐induced conditions . It has been reported that approximately 10% of patients with mycoplasma pneumonia are complicated with eosinophilia .…”