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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 Feb; 72(2):239-45.JA

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.

Authors+Show Affiliations

Department of Dermatology, University of Alabama, Birmingham, Alabama.Department of Dermatology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California.Department of Dermatology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California.Department of Dermatology, University of California, San Francisco, California. Electronic address: ShinkaiK@derm.ucsf.edu.

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

25592340

Citation

Canavan, Theresa N., et al. "Mycoplasma Pneumoniae-induced Rash and Mucositis as a Syndrome Distinct From Stevens-Johnson Syndrome and Erythema Multiforme: a Systematic Review." Journal of the American Academy of Dermatology, vol. 72, no. 2, 2015, pp. 239-45.
Canavan TN, Mathes EF, Frieden I, et al. 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(2):239-45.
Canavan, T. N., Mathes, E. F., Frieden, I., & Shinkai, K. (2015). Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review. Journal of the American Academy of Dermatology, 72(2), 239-45. https://doi.org/10.1016/j.jaad.2014.06.026
Canavan TN, et al. 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(2):239-45. PubMed PMID: 25592340.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review. AU - Canavan,Theresa N, AU - Mathes,Erin F, AU - Frieden,Ilona, AU - Shinkai,Kanade, PY - 2013/12/17/received PY - 2014/06/07/revised PY - 2014/06/11/accepted PY - 2015/1/17/entrez PY - 2015/1/17/pubmed PY - 2015/3/12/medline KW - Mycoplasma pneumoniae KW - Stevens-Johnson syndrome KW - erythema multiforme KW - mucositis KW - rash SP - 239 EP - 45 JF - Journal of the American Academy of Dermatology JO - J. Am. Acad. Dermatol. VL - 72 IS - 2 N2 - 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. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/25592340/Mycoplasma_pneumoniae_induced_rash_and_mucositis_as_a_syndrome_distinct_from_Stevens_Johnson_syndrome_and_erythema_multiforme:_a_systematic_review_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(14)01587-4 DB - PRIME DP - Unbound Medicine ER -