Exantema mucocutáneo inducido por Mycoplasma pneumoniae: ¿un nuevo síndrome separado del eritema multiforme? Un nuevo caso y revisión de la literatura

Fever, cough and mucosal lesions in a young man

“…Mycoplasma pneumoniae (MP) is a frequent cause of respiratory infections and is the pathogen of 40 % of atypical pneumonias, particularly in children and young adults [1][2][3]. It may lead to extrapulmonary involvement, including hemolytic anemia, arthritis, encephalitis and mucocutaneous complications in up to 25 % of patients [1][2][3][4].…”

“…Mycoplasma pneumoniae (MP) is a frequent cause of respiratory infections and is the pathogen of 40 % of atypical pneumonias, particularly in children and young adults [1][2][3]. It may lead to extrapulmonary involvement, including hemolytic anemia, arthritis, encephalitis and mucocutaneous complications in up to 25 % of patients [1][2][3][4]. The dermatological manifestations that have been described include non-specific exanthem, erythema nodosum, urticaria, Raynaud's disease, Kawasaki disease and rashes on the clinical spectrum of epidermal dermatopathies (erythema multiforme, Stevens-Johnson syndrome [SJS] and toxic epidermal necrolysis [TEN]) [1,2,4,5].…”

“…In the literature, we find terms such as "incomplete SJS", "SJS without skin lesions", "atypical SJS" or recently "Fuchs syndrome", "M. pneumoniae-associated mucositis (MPAM)" and "M. pneumoniae-induced rash and mucositis (MIRM) sine rash" to describe patients who, in the context of an MP infection, develop extensive mucositis consistent with SJS, but with minimal or no cutaneous involvement [1,2,[4][5][6][7][8][9][10][11]. Whether MPAM should be considered a separate entity from SJS or it belongs in the same spectrum is still debated [1,2,4,5].…”

“…The pathophysiologic mechanism of MPAM is not completely known [1,2,4,5,11]. It could be explained by molecular mimicry between MP P1-adhesion molecules and a specific antigen that induces the production of cross-reacting autoantibodies by B lymphocytes [1,2,4,11].…”

“…MPAM usually develops in young males (< 18 years), presenting prodromes during the previous week with coughing, fever and general discomfort [1,2,[4][5][6][7][8][9][10][11]. Mucosal involvement is intense and fundamental for the diagnosis, with oral involvement most frequent (94-100 %, with erosions or denudation of the entire mucosa), followed by conjunctival involvement (82-97 %, with bilateral conjunctivitis) and urogenital involvement (63-78 %, with ulcerations and vesiculobullous lesions) [1,4,5].…”