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

https://doi.org/10.1016/j.jaad.2014.06.026Get rights and content

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.

Section snippets

Search strategies

A comprehensive search of the English-language literature was performed on 3 databases: Ovid MEDLINE, PubMed, and EMBASE. Search terms included: “Mycoplasma pneumoniae” or “atypical pneumonia” and “Stevens-Johnson syndrome,” “erythema multiforme,” “toxic epidermal necrolysis,” “mucositis,” “atypical Stevens-Johnson syndrome,” “Fuchs syndrome,” or “Mycoplasma pneumoniae–associated mucositis.” Bibliographies of select publications were reviewed for eligible studies.

Data sources

We included abstracts, case

Results

In all, 256 potential cases of Mycoplasma-associated mucocutaneous disease were identified from 107 reports, of which 202 patients from 95 articles satisfied the inclusion criteria. Twelve articles (54 patients) were excluded because of insufficient morphologic or clinical documentation.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13

Discussion

This systematic review highlights the morphology and clinical course of M pneumoniae–associated mucocutaneous disease that support its designation as a distinct clinical entity. Key features that help to distinguish MIRM from herpes-related erythema multiforme or drug-induced SJS/TEN include young patients, predominance of mucosal involvement, variable though relatively sparse cutaneous involvement, and excellent prognosis.

Despite these differences, most cases of M pneumoniae–associated

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Funding sources: None.

Conflicts of interest: None declared.

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