Mycoplasma Pneumoniae-induced Rash And Mucositis Research Articles

A case of Mycoplasma pneumoniae‐induced rash and mucositis with recent influenza vaccination

AbstractA 33‐year‐old female presented with coryzal symptoms, facial swelling, severe haemorrhagic stomatitis, blistering oral mucositis, conjunctival injection and a sparse targetoid rash on the back and face, requiring admission to hospital. She had received the seasonal influenza vaccination 3 days prior to feeling unwell. Differential diagnosis included erythema multiforme major (EMM) secondary to the influenza vaccine or Mycoplasma pneumoniae‐induced rash and mucositis (MIRM). Oropharyngeal swabs were negative on PCR for cutaneous viruses and Mycoplasma pneumoniae (MP). A skin biopsy from a targetoid lesion on the body showed full thickness epidermal necrosis with epidermal–dermal clefting, numerous civatte bodies and a moderate perivascular infiltrate of lymphocytes and plasma cells in the papillary dermis. She was successfully treated with oral prednisolone and azithromycin. Following discharge from hospital, the paired serological testing for MP returned positive, confirming a diagnosis of MIRM. Our case highlights the difficulties in detecting MP as two diagnostic methods yielded different results, and so we advocate performing both MP PCR and serology to maximise the yield and speed of diagnosis. Secondly, our case highlights the clinical challenge in differentiating MIRM from EMM or Stevens–Johnson syndrome, particularly if there is a potential drug trigger (in our case the influenza vaccine), as all these conditions can feature a severe mucositis with often indistinguishable histological findings. Correct diagnosis of MIRM is important for appropriate and timely administration of anti‐MP antibiotic therapy to facilitate recovery and minimise complications.

Extrapulmonary manifestations of <i>Mycoplasma pneumoniae</i> infection in children

Mycoplasma pneumoniae (M. pn.), which is a well-known pathogen to cause atypical pneumonia, in 25% of cases can lead to a wide range of extra-pulmonary symptoms, reflecting damage to almost any organ or organ system (skin and mucous membranes, nervous, cardiovascular, gastrointestinal, urinary system etc.). Aspecific syndrome Mycoplasma pneumoniae-induced rash and mucositis (MIRM) has been identified recently. Among the CNS manifestations associated with M. pn., acute postinfectious cerebellar ataxia is worth mentioning. In this article we present clinical cases of a 14-year-old boy and a 6-year-old girl with extrapulmonary manifestations of M. pn. infection. This article considers etiological, pathogenetic and clinical features of mycoplasma infection in children with an emphasis on extra-respiratory manifestations.

MIRM o Kawasaki atipica? Uno strano caso di mucosite e febbre

The Authors describe the case of a 2-year-old girl finally diagnosed as MIRM (Mycoplasma pneumoniae-induced rash and mucositis) at first suspected as Kawasaki disease. The antibiotic therapy (azitromicin) was not effective while the clinical resolution was obtained after the IvIgG therapy was started.

M062 STEVENS-JOHNSON SYNDROME OR MYCOPLASMA PNEUMONIAE- INDUCED RASH AND MUCOSITIS: A DIAGNOSTIC DILEMMA

Stevens- Johnson syndrome (SJS) and Mycoplasma pneumoniae- induced rash and mucositis (MIRM) both cause similar muco-cutaneous eruptions. Differences between the two include that SJS affects all ages, is more common in women, and associated with drug and infections, with a mortality rate of about 10%. MIRM affects younger patients, is more common in males, is associated with Mycoplasma infections, and has a milder course, with a mortality rate of around 3%.

Don’t just look at the surface: when mucosa tells more than the skin

A 13-year-old boy was admitted for a 4-day history of fever, malaise, sore throat and cough, treated with amoxicillin for 2 days. Physical examination revealed sparse targetoid cutaneous lesions, stomatitis...

Clinical features of recurrent Mycoplasma pneumoniae-induced rash and mucositis.

The characteristics of patients experiencing recurrent Mycoplasma pneumoniae-induced rash and mucositis (MIRM) are not well understood. We aimed to characterize patients with recurrent disease by comparing the demographics, skin and mucosal involvement, seasonality, and treatment to those with single episodes (isolated MIRM). This retrospective case series screened all patients seen by our dermatology inpatient consult service from September 2014 to March 2020. Cases were selected based on laboratory and clinical criteria that confirmed a diagnosis of MIRM. We identified 13 patients with MIRM: 5 who experienced recurrence (38%) and 8 with isolated, single episodes without recurrence. Mean age was 13.6years for initial episodes in the recurrent patients compared to 11.7 in patients with isolated episodes. All 5 recurrent MIRM patients were male (compared with 75% of isolated MIRM patients) and predominantly Black (60%, compared with 25%). Most episodes overall (isolated and recurrent) occurred from the months of October to February. Recurrences after initial MIRM episode had less severe skin and mucosal findings, often involving only one mucous membrane, less frequent need for hospital admission, and shorter duration of hospital stay. Prophylactic treatments and treatments beyond supportive care were of unclear value. Some characteristics of MIRM differ between patients with recurrent and isolated disease. Clinicians should be aware of the potential for recurrence, which occurred in 38% of our cohort. Although recurrences after initial MIRM episode tended to be less severe, there is still potential for prolonged hospitalizations with recurrent episodes. More evidence is needed regarding effective preventive and treatment regimens in patients with recurrent MIRM.

Mycoplasma Pneumoniae–Induced Rash and Mucositis: A Longitudinal Perspective and Proposed Management Criteria

To evaluate the natural history and ophthalmologic morbidity of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and propose a treatment algorithm. Retrospective, interventional case series. Retrospective chart review of all MIRM patients examined by the department of ophthalmology at a tertiary children's hospital. Diagnosis was established clinically concomitant with either positive Mycoplasma pneumoniae IgM or PCR testing from January 1, 2010, until December 31, 2019. The main outcome measures were best-corrected visual acuity, long-term ocular sequelae, and duration and type of ophthalmic intervention. There were 15 patients (10 male and 5 female) aged 10.9 ± 4.2 years who had primary episodes of MIRM; of those, 4 had multiple episodes. All patients required topical steroid treatment, 3 required amniotic membrane transplantation, and 1 patient underwent placement of a sutureless biologic corneal badage device. There were no patients who suffered visual loss, but 1 was left with mild symblephara near the lateral canthus in each eye and 2 others had scarring of the eyelid margins and blepharitis. The ocular morbidity is significantly less in MIRM than in other closely related syndromes such as erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. However, these patients still require close observation and a low threshold for intervention to avoid permanent ophthalmic sequelae and possible blindness.

Mycoplasma pneumoniae induced rash and mucositis sine rash: a distinct entity of erythema multiforma spectrum

Mycoplasma pneumoniae induced rash and mucositis (MIRM) is a distinct entity of erythema multiforma spectrum. Observation: we report a case of a 19-year-old man hospitalised for multiple mucosal eruptions and hyperthermia for three days, in context of a pro-T lymphoblastic leukemia in complete cytological and molecular remission. Discussion: MIRM is a skin split of 0% – 10% body surface area, at least two mucosal sites involved, few skins including vesiculobullous or atypical targets and evidence of atypical pneumonia. Identification of MP is essential for the correct diagnosis of MIRM and even more differentiation of EM associated with herpes simplex virus and drug-associated. Conclusion: MIRM has a good prognosis with rare recurrence and seldom complications.

The importance of distinguishing Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and Stevens-Johnson syndrome in a clinical setting

The importance of distinguishing Mycoplasma pneumoniae-induced rash and mucositis (MIRM) and Stevens-Johnson syndrome in a clinical setting

Mycoplasma pneumoniae-associated Mucositis: A Recently Described Entity.

Mycoplasma pneumoniae (MP) is a common cause of respiratory infections and can be associated with extrapulmonary complications. MP mucositis has recently been described as a distinct endemic clinical entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM). The authors present the case of a 46-year-old man with atypical pneumonia associated with exuberant mucositis, conjunctival hyperaemia and positive serological assays for MP IgM. The patient was treated with azithromycin and systemic corticosteroid therapy. Supportive care including pain management, intravenous hydration and mucosal care was also given. There was complete resolution of the pneumonia and mucositis. The presence of atypical pneumonia with mucosal involvement without cutaneous lesions and a favourable clinical evolution led to the diagnosis of MIRM.LEARNING POINTSMycoplasma pneumoniae infection can be associated with mucocutaneous lesions. A new entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM) has been recently described. The mucocutaneous involvement associated with MIRM is predominantly mucositis with scarce or absent cutaneous expression.The clinical presentation, pathophysiology and disease outcomes of MIRM distinguish it from Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiform.MIRM has an overall favourable prognosis as the majority of patients recover without sequalae and recurrence is rare.

Mycoplasma pneumoniae-induced mucositis without rash in an 11-year-old boy.

Key Clinical Message Mycoplasma pneumoniae is a frequent cause of childhood pneumonia, and extrapulmonary manifestations may be noted at the time of infection. While M. pneumoniae has long been associated with Stevens–Johnson syndrome, a separate diagnostic entity, Mycoplasma pneumoniae‐induced rash and mucositis (MIRM), has recently been proposed to better characterize the rash and severe mucositis that some patients exhibit. A subset of patients with MIRM will have mucositis without skin rash. Physicians should recognize this clinical entity and be familiar with treatment options for MIRM.

Mycoplasma pneumoniae, more than a lung disease

Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a recently described clinical entity and should be considered in children who present with oral (94% of patients), ocular (82% of patients), and urogenital lesions (63% of patients). MIRM was first described as a distinct clinical entity from Stevens Johnson syndrome/Toxic epidermal necrolysis (SJS)/(TEN) in 2015 [1]. As a new, uncommon diagnosis it frequently poses a diagnostic and therapeutic challenge for pediatricians and dermatologists. We report a case of MIRM in a previously healthy 15-year-old boy.

Mycoplasma-induced pustulosis with perifollicular involvement

Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a disease characterized by mucosal involvement with variable cutaneous manifestations induced by M. pneumoniae infection. Previously reported rash morphologies include vesiculobullous, targetoid, papular, macular, and morbilliform lesions. Pustulosis is a rare presentation of MIRM that has been described only once before in the literature to our knowledge. We report a case of a 13-year-old boy presenting with a pustular skin eruption induced by Mycoplasma infection. Ours' is the second report of MIRM, to our knowledge, presenting with pustulosis and the first, to our knowledge, to first to describe the histopathologic finding of perifollicular neutrophilic infiltration in MIRM.