Skip to main content

Advertisement

SpringerLink
Log in

Mycoplasma-Induced Rash and Mucositis or Steven–Johnson Syndrome

  • Clinical Brief
  • Published:
Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Mycoplasma-induced rash and mucositis (MIRM), has been recently distinguished as an entity distinct from the spectrum of Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN). It is characterized by a younger age of onset, predominant mucosal lesions and sparse skin involvement, in contrast to widespread cutaneous lesions in TEN/SJS. While therapy with azithromycin and a short course of corticosteroids suffices in the majority of cases, intravenous immunoglobulin and cyclosporine may be useful in refractory cases. The authors report a 6-y-old girl with mucopurulent conjunctivitis, hemorrhagic oral mucosal crusting, maculopapular skin rash, and positive serology for Mycoplasma pneumoniae. The girl recovered following therapy with azithromycin and oral prednisolone. The index case is instructive in highlighting a rare complication of a common infection, and delineates the importance of clinical suspicion and a systematic approach to evaluation and management of MIRM in patients with unusual mucosal lesions and skin rash.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

References

  1. Schalock PC, Dinulos JGH. Mycoplasma pneumoniae-induced cutaneous disease. Int J Dermatol. 2009;48:673–80.

    Article  Google Scholar 

  2. Canavan TN, Mathes EF, Frieden I, Shinkai K. Mycoplasma pneumoniae–induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review. J Am Acad Dermatol. 2015;72:239–45.e4.

    Article  Google Scholar 

  3. Simecka JW, Ross SE, Cassell GH, Davis JK. Interactions of mycoplasmas with B cells: antibody production and nonspecific effects. Clin Infect Dis. 1993;17(Suppl 1):S176–82.

    Article  Google Scholar 

  4. Chung W-H, Hung S-I, Yang J-Y, et al. Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis. Nat Med. 2008;14:1343–50.

    Article  CAS  Google Scholar 

  5. Fernald GW. Immunological interactions between host cells and mycoplasmas: an introduction. Rev Infect Dis. 1982;4(Suppl):S201-4.

    Article  Google Scholar 

  6. Michaels B. The role of systemic corticosteroid therapy in erythema multiforme major and Stevens-Johnson syndrome. J Clin Aesthetic Dermatol. 2009;2:51–5.

    Google Scholar 

  7. Vujic I, Shroff A, Grzelka M, et al. Mycoplasma pneumoniae-associated mucositis--case report and systematic review of literature. J Eur Acad Dermatol Venereol. 2015;29:595–8.

    Article  CAS  Google Scholar 

  8. Meyer Sauteur PM, Goetschel P, Lautenschlager S. Mycoplasma pneumoniae and mucositis--part of the Stevens-Johnson syndrome spectrum. J Dtsch Dermatol Ges. 2012;10:740–6.

    PubMed  Google Scholar 

  9. Li HO-Y, Colantonio S, Ramien ML. Treatment of mycoplasma pneumoniae-induced rash and mucositis with cyclosporine. J Cutan Med Surg. 2019;23:608–12.

    Article  CAS  Google Scholar 

  10. Meyer Sauteur PM, Theiler M, Buettcher M, Seiler M, Weibel L, Berger C. Frequency and clinical presentation of mucocutaneous disease due to mycoplasma pneumoniae infection in children with community-acquired pneumonia. JAMA Dermatol. 2019;156:144–50.

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank the patient and her family for consenting to report the case.

Author information

Authors and Affiliations

  1. Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India

    Sharan Thangaraju, Narendra Bagri & Aditi Sinha

  2. Department of Dermatology, All India Institute of Medical Sciences, New Delhi, India

    Vishal Gupta

Authors
  1. Sharan Thangaraju
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Narendra Bagri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vishal Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aditi Sinha
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

ST evaluated the patient and wrote the initial draft of the manuscript; VG, NB and AS made substantial contributions to the evaluation and management of the patient, and contributed to important intellectual content that led to improvements in the manuscript. All authors finally approved the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AS made substantial contributions to the drafting of the work and its revisions and will be accountable for all aspects of the work. Professor Arvind Bagga, Unit Head and Professor, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi will act as guarantor for this paper.

Corresponding author

Correspondence to Aditi Sinha.

Ethics declarations

Conflict of Interest

None.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thangaraju, S., Bagri, N., Gupta, V. et al. Mycoplasma-Induced Rash and Mucositis or Steven–Johnson Syndrome. Indian J Pediatr 88, 802–804 (2021). https://doi.org/10.1007/s12098-021-03658-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12098-021-03658-z

Keywords

Search

Navigation