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Mycoplasma pneumoniae-Associated Mucositis with Minimal Skin Manifestations

  • Case Report
  • M. pneumoniae-Associated Mucositis with Minimal Skin Manifestations
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Abstract

Mycoplasma pneumoniae-associated mucositis is a rarely described complication of M. pneumoniae infection presenting with ocular, oral, and genital involvement but without the typical skin lesions seen in Stevens- Johnson syndrome.

A 27-year-old man with a past history of asthma presented at the emergency room with a 1-week history of cough (initially non-productive but subsequently associated with non-bloody mucopurulent sputum), fever, myalgias, headache, and progressive dyspnea. Two days before admission he had commenced amoxicillin/clavulanic acid with no improvement. The patient reported bilateral conjunctival injection and hemorrhagic ulcers on the lips commencing the day prior to admission. Physical examination revealed fever (39°C), bilateral exudative conjunctivitis, painful hemorrhagic ulcers on the lips, tongue, and oral mucosa, small scrotal erosions, erythema of the penile meatus, and small erythematous bullae on the dorsum of each hand; subsequently, the patient developed bullae at the venipuncture site on his right arm. Laboratory tests revealed positive IgM serology for M. pneumoniae, with titer elevation. The patient was successfully treated with levofloxacin and prednisolone.

Our case appears to be the first adult patient described with M. pneumoniae-associated mucositis, which has previously been reported only in pediatric patients. This is also the first reported instance of a case of M. pneumoniae-associated mucositis treated with levofloxacin and prednisolone. M. pneumoniae infection should be considered in all cases of mucositis, and treatment of this condition with levofloxacin and prednisolone seems to be effective.

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References

  1. Alter SJ, Stringer B. Mycoplasma pneumoniae infections associated with severe mucositis. Clin Pediatr 1990; 10: 602–4

    Article  Google Scholar 

  2. Barfod TS, Pedersen C. Severe stomatitis caused by Mycoplasma pneumoniae infection. ?Ugeskr Laeger 1999; 161: 6363–4

    PubMed  CAS  Google Scholar 

  3. Deborah F, Hesketh EL, Mitchell AE, et al. Mycoplasma pneumoniae infection complicated by pneumomediastinum and severe mucositis. J Pediatr Child Health 2007; 43: 403–5

    Article  Google Scholar 

  4. Kirke S, Powell FC. Mucosal erosions and a cough. Ir Med J 2003; 96: 245

    PubMed  CAS  Google Scholar 

  5. Ravin KA, Rappaport LD, Zuckerbraun NS, et al. Mycoplasma pneumoniae and atypical Stevens-Johnson syndrome: a case series. Pediatrics 1997; 119: e1002–5

    Article  Google Scholar 

  6. Schalock PC, Dinulos JGH. Mycoplasma pneumoniae-induced Stevens Johnson syndrome without skin lesions: fact or fiction? J Am Acad Dermatol 2005; 52: 312–5

    Article  PubMed  Google Scholar 

  7. Sieber OF, John J, Fulginiti VA, et al. Stevens-Johnson syndrome associated with Mycoplasma pneumoniae infection. JAMA 1967; 200: 79–81

    Article  PubMed  Google Scholar 

  8. Vanfleteren I, Van Gysel D, de Brandt C. Stevens-Johnson syndrome: a diagnostic challenge in the absence of skin lesions. Pediatr Dermatol 2003; 20: 52–6

    Article  PubMed  Google Scholar 

  9. Latsch K, Girschick HJ, Abele-Horn M. Stevens Johnson syndrome without skin lesions. J Med Microbiol 2007; 56: 1696–9

    Article  PubMed  CAS  Google Scholar 

  10. Eaton MD, Meiklejohn G, Van Herick W. Studies on the etiology of primary atypical pneumonia: a filterable agent transmissible to cotton rats, hamsters, and chick embryos. J Exp Med 1944; 79: 649–67

    Article  PubMed  CAS  Google Scholar 

  11. Chanock RM, Hayflick L, Barile MF. Growth on artificial medium of agent associated with atypical pneumonia and its identification as a PPLO. Proc Natl Acad Sci USA 1962; 48: 41–9

    Article  PubMed  CAS  Google Scholar 

  12. Chanock RM, Dienes L, Eaton MD. Mycoplasma pneumoniae: proposed nomen-clature for atypical pneumonia organism (Eaton agent). Science 1963; 140: 662

    Article  PubMed  CAS  Google Scholar 

  13. Blasi F, Tarsia P, Aliberti A, et al. Chlamydia pneumoniae and Mycoplasma pneumoniae. Sem Respir Crit Care Med 2005; 26: 617–24

    Article  Google Scholar 

  14. Waites KB, Talkington F. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004; 17: 697–728

    Article  PubMed  CAS  Google Scholar 

  15. Cimolai N, Wensley D, Seear M, et al. Mycoplasma pneumoniae as a cofactor in severe respiratory infections. Clin Infect Dis 1995; 21: 1182–5

    Article  PubMed  CAS  Google Scholar 

  16. Nadala D, Bossart W, Zucol F, et al. Community-acquired pneumonia in children due to Mycoplasma pneumoniae: diagnostic performance of a seminested 16S rDNA-PCR. Diagn Microbiol Infect Dis 2001; 39: 15–9

    Article  CAS  Google Scholar 

  17. Souliou E, Almasri M, Papa A, et al. Laboratory diagnosis of Mycoplasma pneumoniae respiratory tract infections in children. Eur J Clin Microbiol Infect Dis 2007; 26: 513–5

    Article  PubMed  CAS  Google Scholar 

  18. Thacker WL, Talkington DF. Analysis of complement fixation and commercial enzyme immunoassays for detection of antibodies to Mycoplasma pneumoniae in human serum. Clin Diagn Lab Immunol 2000; 7: 778–80

    PubMed  CAS  Google Scholar 

  19. Waris ME, Toikka P, Saarinen T, et al. Diagnosis of Mycoplasma pneumoniae pneumonia in children. J Clin Microbiol 1998; 36: 3155–9

    PubMed  CAS  Google Scholar 

  20. Putman CE, Curtis AM, Simeone JF, et al. Mycoplasma pneumoniae: clinical and roentgenographic patterns. Am J Roentgenol Radium Ther Nucl Med 1975; 124: 417–22

    PubMed  CAS  Google Scholar 

  21. Lee I, Kim TS, Yoon H. Mycoplasma pneumoniae pneumonia: CT features in 16 patients. Eur Radiol 2006; 16: 719–25

    Article  PubMed  Google Scholar 

  22. Okada F, Ando Y, Wakisaka M, et al. Chlamydia pneumoniae pneumonia and Mycoplasma pneumoniae pneumonia: comparison of clinical findings and CT findings. J Comput Assist Tomogr 2005; 29: 626–32

    Article  PubMed  Google Scholar 

  23. Stevens AM, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia. Am J Dis Child 1922; 24: 526–33

    Google Scholar 

  24. Lind K. Mucocutaneous reactions during Mycoplasma pneumoniae infection. Lancet 1978; I: 655

    Article  Google Scholar 

  25. Sontheimer RD, Garibaldi RA, Krueger GG. Stevens-Johnson syndrome associated with Mycoplasma pneumoniae infections. Arch Dermatol 1978; 114: 241–4

    Article  PubMed  CAS  Google Scholar 

  26. Stanyon JH, Warner WP. Mucosal respiratory syndrome. Can Med Assoc J 1945; 53: 427–34

    PubMed  CAS  Google Scholar 

  27. Huff JC, Weston WL, Tonnesen MG. Erythema multiforme: a critical review of characteristics, diagnostic criteria and causes. J Am Acad Dermatol 1983; 8: 763–75

    Article  PubMed  CAS  Google Scholar 

  28. Lucier TS, Heitzman K, Liu SK, et al. Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae. Antimicrob Agents Chemother 1995; 39: 2770–3

    Article  PubMed  CAS  Google Scholar 

  29. Matsuoka M, Narita M, Okazaki N, et al. Characterization and molecular analysis of macrolide-resistant Mycoplasma pneumoniae: clinical isolates obtained in Japan. Antimicrob Agents Chemother 2004; 48: 4624–30

    Article  PubMed  CAS  Google Scholar 

  30. Cheriyan S, Patterson R, Greenberger PA, et al. The outcome of Stevens-Johnson syndrome treated with corticosteroids. Allergy Proc 1995; 16: 151–5

    Article  PubMed  CAS  Google Scholar 

  31. Patterson R, Grammer LC, Greenberger PA, et al. Stevens-Johnson syndrome (SJS): effectiveness of corticosteroids in management and recurrent SJS. Allergy Proc 1992; 12: 89–95

    Article  Google Scholar 

  32. Patterson R, Miller M, Kaplan M, at al. Effectiveness of early therapy with corticosteroids in Stevens-Johnson syndrome: experience with 41 cases and a hypothesis regarding pathogenesis. Ann Allergy 1994; 73: 27–34

    PubMed  CAS  Google Scholar 

  33. Tripathi A, Ditto AM, Grammer LC, et al. Corticosteroid therapy in an additional 13 cases of Stevens-Johnson syndrome: a total series of 67 cases. Allergy Asthma Proc 2000; 21: 101–5

    Article  PubMed  CAS  Google Scholar 

  34. Mittmann N, Chan B, Knowles S, et al. Intravenous immunoglobulin use in patients with toxic epidermal necrolysis and Stevens-Johnson syndrome. Am J Clin Dermatol 2006; 7: 359–68

    Article  PubMed  Google Scholar 

  35. Zipitis CS, Thalange N. Intravenous immunoglobulins for the management of Stevens-Johnson syndrome with minimal skin manifestations. Eur J Pediatr 2007; 166: 585–8

    Article  PubMed  CAS  Google Scholar 

  36. Bachot N, Revuz J, Roujeau JC. Intravenous immunoglobulin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis: a prospective noncom- parative study showing no benefit on mortality or progression. Arch Dermatol 2003; 139: 33–6

    Article  PubMed  CAS  Google Scholar 

  37. Brett AS, Philips D, Lynn AW. Intravenous immunoglobulin therapy for Stevens-Johnson syndrome. South Med J 2001; 94: 342–3

    PubMed  CAS  Google Scholar 

  38. Prins C, Vittorio C, Padilla RS, et al. Effect of high-dose intravenous immunoglobulin therapy in Stevens-Johnson syndrome: a retrospective, multicenter study. Dermatology 2003; 207: 96–9

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

No sources of funding were used to assist in the preparation of this case report. The authors have no conflicts of interest that are directly relevant to the content of this case report.

The authors would like to thank Dr António Murinello for his assistance in the preparation of this article.

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Authors and Affiliations

  1. Unit of Internal Medicine 1 - Hospital Curry Cabral, Lisbon, Portugal

    Joaõ Figueira-Coelho, Sofia Lourenço, Ana Cristina Pires, Paula Mendonça & José António Malhado

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  1. Joaõ Figueira-Coelho
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  2. Sofia Lourenço
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  3. Ana Cristina Pires
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  4. Paula Mendonça
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  5. José António Malhado
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Correspondence to Joaõ Figueira-Coelho.

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Figueira-Coelho, J., Lourenço, S., Pires, A.C. et al. Mycoplasma pneumoniae-Associated Mucositis with Minimal Skin Manifestations. Am J Clin Dermatol 9, 399–403 (2008). https://doi.org/10.2165/0128071-200809060-00008

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  • DOI: https://doi.org/10.2165/0128071-200809060-00008

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