Mycoplasma pneumoniae and mucositis – part of the Stevens-Johnson syndrome spectrum
Article first published online: 4 JUN 2012
© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin
JDDG: Journal der Deutschen Dermatologischen Gesellschaft
Volume 10, Issue 10, pages 740–745, October 2012
How to Cite
Meyer Sauteur, P. M., Goetschel, P. and Lautenschlager, S. (2012), Mycoplasma pneumoniae and mucositis – part of the Stevens-Johnson syndrome spectrum. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 10: 740–745. doi: 10.1111/j.1610-0387.2012.07951.x
- Issue published online: 26 SEP 2012
- Article first published online: 4 JUN 2012
- Submitted: 15.1.2012 | Accepted: 12.3.2012
- Mycoplasma pneumoniae;
- Stevens-Johnson syndrome;
- Erythema multiforme;
- Intravenous immunoglobulin
Background: Mycoplasma pneumoniae may induce mucosal inflammation, referred to as M. pneumoniae-associated mucositis (MPAM). There is no generally accepted definition of MPAM, since there may be mucosal lesions only, or mucosal and minimal skin lesions.
Patients and Methods: We conducted a literature review of MPAM, paying particular attention to pathogenesis, clinical manifestations, treatment decisions, and prognosis.
Results: We identified 32 cases of MPAM (median age 13.5 years), whereof 23 patients were otherwise healthy children and young adolescents (72%). M. pneumoniae infection was associated with fever and respiratory symptoms in all calls; it was confirmed by serology (n = 30) and/or PCR (n = 9). Oral lesions were present in all cases, followed by ocular (97%) and uro-genital lesions (78%). Despite the syndrome's name postulating the absence of cutaneous involvement, minimal skin lesions occurred in 31%. Treatment regimens included systemic antibiotics (100%) and systemic anti-inflammatory treatment with corticosteroids (31%) or immunoglobulins (9%). Macrolides were given in 81%, with failure, relapse, and/or worsening in one-third of patients. No patient suffered long-term sequelae.
Conclusion: MPAM is a distinct extra-pulmonary manifestation falling into the continuum of Stevens-Johnson syndrome. This entity may be due to inflammatory mechanisms suggesting that systemic anti-inflammatory treatment is even more important than antimicrobials.