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Mycoplasma pneumonia--associated mucocutaneous disease in children: dilemmas in classification

Brea Prindaville1, Brandon D Newell, Amy J Nopper

  • 1Division of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri.

Pediatric Dermatology
|November 27, 2014
PubMed

Insights

Mycoplasma pneumoniae infections in children often present as Stevens-Johnson syndrome (SJS) or erythema multiforme (EM) major. This study found that most Mycoplasma-associated cases in children were reclassified as EM major, showing significant mucosal but limited skin involvement.

Area of Science:

  • Pediatrics
  • Dermatology
  • Infectious Diseases

Background:

  • Stevens-Johnson syndrome (SJS) and erythema multiforme (EM) major share overlapping clinical features, leading to diagnostic challenges.
  • Mycoplasma pneumoniae infections are associated with SJS and EM major, particularly in children, though Mycoplasma is more frequently linked to SJS.

Purpose of the Study:

  • To characterize Mycoplasma-associated mucocutaneous disease in children.
  • To differentiate between SJS and EM major in pediatric cases associated with Mycoplasma pneumoniae.

Main Methods:

  • Retrospective chart review of six children hospitalized with SJS and positive Mycoplasma infection over 10 years.
  • Retrospective diagnosis of SJS or EM major based on cutaneous lesional morphology using the Bastuji-Garin classification system, supported by physical examinations and photographs.

Main Results:

  • The majority of patients were boys with limited acral cutaneous lesions.
  • All patients experienced prolonged hospitalization due to significant mucosal involvement, with good short-term outcomes.
  • Retrospective application of the classification system reclassified five of six patients from SJS to EM major.

Conclusions:

  • Mycoplasma-associated mucocutaneous disease in children often presents with significant mucosal involvement but less extensive cutaneous lesions.
  • The clinical presentation in these cases is more characteristic of EM major than SJS, suggesting a need for refined diagnostic criteria.

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