<i>Mycoplasma pneumoniae</i> and Atypical Stevens-Johnson Syndrome: A Case Series

Ravin, Karen; Rappaport, Lara; Zuckerbraun, Noel S.; Wadowsky, Robert M.; Wald, Ellen R.; Michaels, Marian M.

doi:10.1542/peds.2006-2401

Cited by 69 publications

(59 citation statements)

References 13 publications

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“…3 There have been several case reports in which Mycoplasma infection is localized to the mucous membranes with very little to no skin involvement. [4][5][6] Patients will often have ocular, oral, and genital involvement as in our patient. This was previously known as atypical SJS but it has been suggested that the term Mycoplasma pneumoniaeassociated mucositis would be a more appropriate definition.…”

Section: Discussionmentioning

confidence: 64%

A 13-Year-Old Boy with Pharyngitis, Oral Ulcers, and Dehydration

Trapp¹,

Schrantz²,

Joseph-Griffin³

et al. 2013

Pediatr Ann

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A 13-year-old boy with no significant past medical history was admitted to our institution with pharyngitis, oral ulcers, and dehydration. He was well until 8 days prior to admission when he developed a fever to 103 o F and pharyngitis. He was seen by his primary care physician, who ordered a rapid strep test and throat culture, both of which were negative, so symptomatic care was recommended.Four days prior to admission the patient developed ulcers on the inside of his mouth and lips. He was seen again by his primary care physician and started on antiviral medication and ibuprofen with hydrocodone, and a herpes simplex virus-polymerase chain reaction test was ordered. Mouth pain became so severe that the patient was unable to remain adequately hydrated. He was admitted to the hospital for pain control, intravenous fluids, and further work-up.In the 2 days prior to presentation to the hospital, he developed painful lesions on the glans of his penis. Recent medication use included NyQuil (Vicks), Theraflu (Novartis), Famvir (Novartis) and Vicoprofen (Abbott). The patient denied any history of sexual activity or For diagnosis, see page 149Editor's note: Each month, this department features a discussion of an unusual diagnosis in genetics, radiology, or dermatology. A description and images are presented, followed by the diagnosis and an explanation of how the diagnosis was determined. As always, your comments are welcome via email at Pediatrics@Healio.com.

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Section: Discussionmentioning

confidence: 64%

A 13-Year-Old Boy with Pharyngitis, Oral Ulcers, and Dehydration

Trapp¹,

Schrantz²,

Joseph-Griffin³

et al. 2013

Pediatr Ann

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“…7 SJS was classically ascribed to a medication hypersensitivity reaction; however, infectious etiologies, including Mycoplasma pneumoniae (Mp), are increasingly recognized as inciting agents. [8][9][10] SJS has an estimated incidence of 1 to 7 cases per million person-years, [11][12][13][14][15] although pediatric rates are not well described because of a lack of published information. Epidemiologic clusters of SJS are exceptionally rare and have been associated with both medications (including mebendazole and metronidazole) 16 and infection such as Mp.…”

Section: Stevens-johnson Syndrome (Sjs) Ismentioning

confidence: 99%

“…Epidemiologic clusters of SJS are exceptionally rare and have been associated with both medications (including mebendazole and metronidazole) 16 and infection such as Mp. 9,17,18 SJS attributed to Mp represents only a small fraction of overall cases, and published information about the clinical characteristics of this condition is limited to small case series.…”

Section: Stevens-johnson Syndrome (Sjs) Ismentioning

confidence: 99%

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Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

et al. 2015

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BACKGROUND: Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado.METHODS: Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection.RESULTS: During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 10.0, confidence interval [CI] 1.3-5.1), preceding respiratory symptoms (OR 30.0, CI 1.6-72.6), an erythrocyte sedimentation rate $35 mg/dL (OR 22.8, CI 2.1-244.9), and #3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23). CONCLUSIONS:We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.WHAT'S KNOWN ON THIS SUBJECT: StevensJohnson syndrome (SJS) is a rare and severe immunologic phenomenon characterized by rash and mucous membrane disease. SJS may be triggered by medications and, less commonly, by infections such as Mycoplasma pneumoniae (Mp). Outbreaks of SJS are exceedingly rare. WHAT THIS STUDY ADDS:We describe the largest SJS outbreak reported in children, which was also Mp-associated. In the first case-control study of this disease, we identify predictors of Mp-associated SJS versus non-Mp-associated SJS, including fewer skin lesions, pneumonia, and elevated erythrocyte sedimentation rate.

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“…In children, M. pneumoniae is also the most commonly-identified infectious cause of StevensJohnson syndrome. Classic rash and mucosal involvement accompany the signs and symptoms of an M. pneumoniae respiratory infection [47]. It can also cause urticaria, toxic epidermal necrolysis and pityriasis rosea [8,15].…”

Section: Dermatological Manifestationsmentioning

confidence: 99%

Infection by Mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias

Vervloet¹,

Marguet²,

Camargos

2007

Braz J Infect Dis

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This manuscript reviewed the literature on infection by Mycoplasma pneumoniae with emphasis on etiological aspects of childhood community-acquired pneumonias. Bibliographical research was carried out from Pubmed Medline, MDConsult, HighWire, LILACS, and direct research over the past 10 years with the following keywords: Mycoplasma pneumoniae, pneumonia, and childhood. Fifty-four articles were selected. Mycoplasma pneumoniae has a high incidence in childhood. Clinical presentation includes respiratory and extrarespiratory symptoms. Mycoplasma pneumoniae lung infection can be confused with viral or bacterial pneumonia and is unresponsive to beta-lactams. In addition, co-infections have been reported. Mycoplasma pneumoniae infection occurs in all age groups, being less frequent and more severe in children under the age of five. Its incidence as a causal agent is high. Mycoplasma pneumoniae infections constitute 20%-40% of all community-acquired pneumonias; the severity is highly variable, and this condition may lead to severe sequelae. Mycoplasma pneumoniae frequency is underestimated in clinical practice because of the lack of specific features and a diagnosis that needs serology or PCR. Effective management of M. pneumoniae infections can usually be achieved with macrolides. In Brazil, epidemiological studies are needed in order to assess the incidence of this bacterium.

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Mycoplasma pneumoniae and Atypical Stevens-Johnson Syndrome: A Case Series

Cited by 69 publications

References 13 publications

A 13-Year-Old Boy with Pharyngitis, Oral Ulcers, and Dehydration

A 13-Year-Old Boy with Pharyngitis, Oral Ulcers, and Dehydration

Outbreak of Mycoplasma pneumoniae–Associated Stevens-Johnson Syndrome

Infection by Mycoplasma pneumoniae and its importance as an etiological agent in childhood community-acquired pneumonias

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