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Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM?
J Pediatric Infect Dis Soc. 2020 Apr 10 [Online ahead of print]JP

Abstract

INTRODUCTION

A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM.

CASE PRESENTATION

A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered.

DISCUSSION

Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient's symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.

Authors+Show Affiliations

Loyola Stritch School of Medicine, Maywood, Illinois, USA.Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA.Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA.Department of Pediatrics, Loyola University Medical Center, Maywood, Illinois, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32275058

Citation

Brazel, Danielle, et al. "Rash and Mucositis Associated With Mycoplasma Pneumoniae and Chlamydophila Pneumoniae: a Recurrence of MIRM?" Journal of the Pediatric Infectious Diseases Society, 2020.
Brazel D, Kulp B, Bautista G, et al. Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM? J Pediatric Infect Dis Soc. 2020.
Brazel, D., Kulp, B., Bautista, G., & Bonwit, A. (2020). Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM? Journal of the Pediatric Infectious Diseases Society. https://doi.org/10.1093/jpids/piaa028
Brazel D, et al. Rash and Mucositis Associated With Mycoplasma Pneumoniae and Chlamydophila Pneumoniae: a Recurrence of MIRM. J Pediatric Infect Dis Soc. 2020 Apr 10; PubMed PMID: 32275058.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM? AU - Brazel,Danielle, AU - Kulp,Brooke, AU - Bautista,Geoanna, AU - Bonwit,Andrew, Y1 - 2020/04/10/ PY - 2019/11/13/received PY - 2020/03/13/accepted PY - 2020/4/11/entrez PY - 2020/4/11/pubmed PY - 2020/4/11/medline KW - Chlamydophila pneumoniae KW - Mycoplasma pneumoniae KW - Mycoplasma-induced rash and mucositis KW - EM KW - IVIG KW - MIRM KW - SJS KW - Stevens-Johnson syndrome KW - conjunctivitis KW - dermatology KW - erythema multiforme KW - infectious disease KW - mucositis KW - pediatrics KW - rash JF - Journal of the Pediatric Infectious Diseases Society JO - J Pediatric Infect Dis Soc N2 - INTRODUCTION: A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM. CASE PRESENTATION: A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered. DISCUSSION: Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient's symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options. SN - 2048-7207 UR - https://www.unboundmedicine.com/medline/citation/32275058/Rash_and_Mucositis_Associated_With_Mycoplasma_pneumoniae_and_Chlamydophila_pneumoniae:_A_Recurrence_of_MIRM L2 - https://academic.oup.com/jpids/article-lookup/doi/10.1093/jpids/piaa028 DB - PRIME DP - Unbound Medicine ER -
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