Mycoplasma pneumoniae-induced rash and mucositis: a recently described entity

Abstract

Mycoplasmapneumoniaeis a common cause of respiratory infections. Although most cases are mild, some patients have extrapulmonary complications including mucocutaneous eruptions including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and erythemamultiforme (EM). Recently, a new entity, calledM. pneumoniae-induced rash and mucositis (MIRM) was described. The authors present a clinical case difficult to classify attending to the classical classification of epidermolytic syndromes that meets the criteria proposed for the diagnosis of MIRM. The mucocutaneous disease associated withM. pneumoniaepresents predominant mucositis, with scarce or absent cutaneous involvement. Because of the distinct morphology, pathophysiology and benign clinical course, MIRM should be considered as a new entity, distinct from SJS/TEN and EM.

Fever, cough and mucosal lesions in a young man

“…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].…”

“…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].…”

“…It has also been suggested that systemic treatment with anti-inflammatory agents may be more important than treatment with antimicrobials, since the effects on MPAM are probably due to inhibition of inflammatory mechanisms rather than direct effects on MP [4]. The clinical course is usually favorable, with complete recovery in over 80 % of cases and a low percentage of long-term sequelae [1,2,4,5,[7][8][9][10][11]. However, some previous cases required intensive care [1,5] and patients should therefore be monitored closely [1,2,[4][5][6]10].…”

Mycoplasma pneumoniae-associated Mucositis: A Recently Described Entity

“…In 25% of cases there are extrapulmonary complications, namely mucocutaneous lesions [1–5] . The MP spectrum of dermatological manifestations is varied and includes Raynaud’s disease, erythema nodosum, Kawasaki disease, erythema multiforme (EM) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) [2–5]. Mucositis with or without scarce cutaneous involvement associated with MP infection is rare.…”

“…Mucositis with or without scarce cutaneous involvement associated with MP infection is rare. Previously this clinical condition was classified within the epidermolytic dermopathy spectrum, being classified as ‘atypical SSJ’, ‘incomplete SSJ’ or ‘Fuchs syndrome’ [1,2,4] . A recent systematic review concluded that this condition is actually a distinct entity called Mycoplasma pneumoniae -induced rash and mucositis (MIRM) [1] .…”