Mycoplasma pneumoniae-Induced Mucocutaneous Rash: A New Syndrome Distinct from Erythema Multiforme? Report of a New Case and Review of the Literature

Martínez-Pérez, Marcela; Imbernón-Moya, Adrián; Lobato‐Berezo, Alejandro; Churruca-Grijelmo, Micaela

doi:10.1016/j.adengl.2016.06.005

Cited by 12 publications

(21 citation statements)

References 13 publications

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“…However, no patient with MIRM has been reported in China until now, indicating that many clinicians had no knowledge of this disease and that such patients could be misdiagnosed. MIRM is more often characterized by prominent mucositis with a single lesion or a few scattered skin lesions (10,13,14,17,18), commonly in children and young adolescents (11). The mean age of onset in our cohort was 5.5 years.…”

Section: Discussionmentioning

confidence: 89%

“…Previously, this clinical condition was classified within the epidermolytic dermopathy spectrum as "atypical SJS, " "incomplete SJS, " or "Fuchs syndrome" (5,10,11,14,15). Recently, a systematic review concluded that this condition was a distinct entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM) (11,(14)(15)(16)(17). However, no patient with MIRM has been reported in China until now, indicating that many clinicians had no knowledge of this disease and that such patients could be misdiagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…The pathological mechanism of MIRM is currently unclear. MIRM is currently believed to be caused by polyclonal B-cell proliferation, and antibody production may theoretically result in skin damage stemming from immune complex and complement deposition (14,41,42). And there was a protein-homeostasissystem hypothesis proposed, it is possible that inflammationinducing substances in M. pneumoniae infection are produced when pathogens are replicated within host cells, including toxins and pathogen-associated molecular patterns (PAMPs), and/or those originated from injured infected-host cells including damage-associated molecular patterns (DAMPs), pathogenic proteins, and pathogenic peptides.…”

Section: Discussionmentioning

confidence: 99%

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Case Report: Clinical and Immunological Features of a Chinese Cohort With Mycoplasma-Induced Rash and Mucositis

et al. 2020

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Dermatological disorders are the most common extrapulmonary complications of Mycoplasma pneumoniae, of which Mycoplasma-induced rash and mucositis (MIRM) has recently been proposed to be a separate diagnostic entity. MIRM could easily be misdiagnosed as atypical Stevens-Johnson syndrome by clinicians due to the unawareness of this rare disease. We retrospectively reviewed the inpatient database from Jan. 2016 to Dec. 2019 of the Children's Hospital of Fudan University. In total, five patients (mean age 5.5 years, three male) matched the diagnostic criteria of MIRM. All patients had scattered lesions and more than two sites of mucosal involvement. The serum IgA level of three patients was higher than normal. Two patients had a significant decrease in peripheral blood CD3+ T and CD4+ T cells that improved with recovery. The percentage of TCRαβ+ CD4-CD8-T cells of Patient five was higher than normal. All patients received treatments with antibiotics and corticosteroids, 3 patients received intravenous immunoglobulin. Among five patients, three patients complained of dyspigmentation, and two patients had an uneventful recovery. MIRM is a separate entity with predominant mucosal involvement and excellent prognosis that more often affects younger patients. Excessive inflammatory reactions may lead to immune disorders, including lymphopenia and a redistribution of CD4+ T cells. We recommend that pneumonia accompanied by mucocutaneous eruptions, especially in young patients, should raise clinical suspicion of MIRM.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case Report: Clinical and Immunological Features of a Chinese Cohort With Mycoplasma-Induced Rash and Mucositis

et al. 2020

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“…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].…”

Section: Diskussionunclassified

“…Weiterhin wurden in einigen Fällen intravenöse Immunglobuline (IVIG) angewendet, in Einzelfällen sogar Plasmapherese. Eine eindeutige Evidenz für die Therapie liegt jedoch leider nicht vor [4,6].…”

Section: Diskussionunclassified

Mycoplasmen-assoziierte Haut- und Schleimhautveränderungen

et al. 2018

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ZusammenfassungIm Zusammenhang mit einer Mycoplasma pneumoniae-Infektion können erosive Haut- und Schleimhautveränderungen auftreten. Diese wurden als Erythema multiforme, Steven-Johnson-Syndrom oder toxische epidermale Nekrolyse beschrieben. In den meisten Fällen dominiert eine ausgeprägte Mukositis, wohingegen die Hautveränderungen des restlichen Integuments meist nur sehr spärlich auftreten und als atypische Kokarden beschrieben werden.Einige Autoren postulieren ein eigenständiges dermatologisches Krankheitsbild, das durch Mycoplasma pneumoniae induziert wird und vordergründig zu einer Mukositis mit diskreter Beteiligung der Haut und Augen führen kann.Wir stellen zwei Kasuistiken vor, welche im Rahmen einer nachgewiesenen MP-Pneumonie ausgeprägte Hautveränderungen aufwiesen, die nicht eindeutig einem Erythema multiforme oder Steven-Johnson-Syndrom zugeordnet werden konnten. Beide Patienten gaben an, initial Erkältungssymptome bemerkt zu haben, welche auch medikamentös behandelt wurden, sodass auch eine Medikamentennebenwirkung nicht ausgeschlossen werden konnte.Unter der Therapie mit systemischen Kortikosteroiden, Antibiotika bei Nachweis von MP und intensiver Lokaltherapie zeigten sich die Hautveränderungen komplett rückläufig. Die Beschreibung dieser beiden Fälle fügt sich in die Reihe des neu definierten dermatologischen Krankheitsbildes bei einer Mycoplasma pneumoniae-Infektion.

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

Santos¹,

Silva

Vieira

et al. 2017

BMJ Case Reports

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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.

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Mycoplasma pneumoniae-Induced Mucocutaneous Rash: A New Syndrome Distinct from Erythema Multiforme? Report of a New Case and Review of the Literature

Cited by 12 publications

References 13 publications

Case Report: Clinical and Immunological Features of a Chinese Cohort With Mycoplasma-Induced Rash and Mucositis

Case Report: Clinical and Immunological Features of a Chinese Cohort With Mycoplasma-Induced Rash and Mucositis

Mycoplasmen-assoziierte Haut- und Schleimhautveränderungen

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

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