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Journal of the American Academy of Dermatology
Volume 72, n° 2
page 239 (février 2015)
Doi : 10.1016/j.jaad.2014.06.026
accepted : 11 June 2014
Original Articles

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

Theresa N. Canavan, MD a, Erin F. Mathes, MD b, c, Ilona Frieden, MD b, c, Kanade Shinkai, MD, PhD b,
a Department of Dermatology, University of Alabama, Birmingham, Alabama 
b Department of Dermatology, University of California, San Francisco, California 
c Department of Pediatrics, University of California, San Francisco, California 

Reprint requests: Kanade Shinkai, MD, PhD, Department of Dermatology, University of California, 1701 Divisadero St, Third Floor, Box 0316, San Francisco, CA 94115.
Abstract
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.

The full text of this article is available in PDF format.

Key words : erythema multiforme, mucositis, Mycoplasma pneumoniae , rash, Stevens-Johnson syndrome

Abbreviations used : IVIG, MIRM, SJS, TEN



 The reference list for this article is available at www.jaad.org.
 Funding sources: None.
 Conflicts of interest: None declared.



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