Mycoplasma pneumoniae –induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: A systematic review

• Published in: Journal of the American Academy of Dermatology 2015-02, Vol.72 (2), p.239-245.e4
• Main Authors: Canavan, Theresa N., MD, Mathes, Erin F., MD, Frieden, Ilona, MD, Shinkai, Kanade, MD, PhD
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Age Distribution; Anti-Bacterial Agents - therapeutic use; Child; Dermatology; Diagnosis, Differential; erythema multiforme; Erythema Multiforme - diagnosis; Exanthema - diagnosis; Exanthema - drug therapy; Exanthema - microbiology; Female; Humans; Immunoglobulins, Intravenous - therapeutic use; Male; mucositis; Mucositis - drug therapy; Mucositis - microbiology; Mycoplasma Infections - diagnosis; Mycoplasma Infections - drug therapy; Mycoplasma pneumoniae; Mycoplasma pneumoniae - isolation & purification; rash; Sex Distribution; Stevens-Johnson syndrome; Stevens-Johnson Syndrome - diagnosis; Syndrome; Treatment Outcome
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2014.06.026

Background Mycoplasma pneumoniae infection is associated with extrapulmonary complications, including mucocutaneous eruptions. These eruptions, which have been termed either “Stevens-Johnson syndrome” or “erythema multiforme” in the literature, may differ from drug-induced Stevens-Johnson syndrome or viral-associated erythema multiforme. Objective We sought to review the literature characterizing morphology and disease course of M pneumoniae –associated mucocutaneous disease. Methods A comprehensive literature search identified 95 articles with 202 cases. Results Patients were often young (mean age: 11.9 years) and male (66%). Cutaneous involvement ranged from absent (34%), to sparse (47%), to moderate (19%). Oral, ocular, and urogenital mucositis was reported in 94%, 82%, and 63% of cases, respectively. Treatments included antibiotics (80%), systemic corticosteroids (35%), supportive care alone (8%), and/or intravenous immunoglobulin (8%). Complications included mucosal damage (10%), cutaneous scarring (5.6%), recurrence (8%), and mortality (3%). Limitations Mild cases may not have been published; thus this review may have a bias toward more severe disease. Conclusion M pneumoniae –associated mucocutaneous disease has prominent mucositis and sparse cutaneous involvement, although cutaneous involvement varies. Because of the distinct morphology, mild disease course, and potentially important clinical implications regarding treatment, we propose a revision of the nomenclature system and suggest the term “ Mycoplasma -induced rash and mucositis” for these cases.