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Case Report: Mycoplasma pneumoniae-induced rash and mucositis in a child
Xiaoying Mo1, Meihua Wang1, Xue Jiang1
1Department of Infection, Nantong Third People's Hospital, Affiliated Nantong Hospital 3 of Nantong University, Nantong, Jiangsu, China.
Rationale:
Mycoplasma pneumoniae (MP) is a common pathogen responsible for pediatric community-acquired pneumonia. MP infection can also induce extrapulmonary manifestations, including mucocutaneous eruptions. Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a relatively newly described entity distinct from erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). However, MIRM remains underrecognized, with limited cases reported in China.
Patient Concerns:
A previously healthy 10-year-old boy presented with fever, cough, severe mucositis (oral and ocular involvement), and disseminated rash for 5 days.
Diagnoses:
The patient was diagnosed with Mycoplasma pneumoniae-induced rash and mucositis (MIRM), confirmed by clinical presentation and laboratory detection of MP nucleic acid.
Interventions:
The treatment regimen for the patient included intravenous azithromycin, methylprednisolone at a dosage of 1 mg/kg/day, intravenous immunoglobulin (IVIG), vitamin C, oral antihistamines, topical treatments for mucosal care, ophthalmic ointment, and calamine lotion. After 1 week, due to a persistent cough and a positive Mycoplasma pneumoniae (MP) nucleic acid test, the patient's treatment was transitioned to oral doxycycline.
Outcomes:
The patient experienced significant clinical improvement after 14 days, with resolution of rash, mucosal lesions, and cough. Follow-up tests confirmed clearance of MP nucleic acid and normalization of inflammatory markers.
Lessons:
MIRM is a distinct mucocutaneous entity associated with MP infection. Pediatricians should recognize its clinical presentation early to provide prompt targeted therapy and supportive care, thus preventing complications.
Insights
Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a distinct condition causing severe mucocutaneous eruptions in children. Early recognition and treatment are crucial for prompt recovery and preventing complications.
Area of Science:
- Pediatric infectious diseases
- Dermatology
- Clinical immunology
Background:
- Mycoplasma pneumoniae (MP) is a common cause of pediatric pneumonia and can lead to extrapulmonary manifestations.
- Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a distinct entity, differentiated from erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).
- MIRM is underrecognized, particularly in certain regions like China, highlighting a need for increased awareness.
Observation:
- A 10-year-old boy presented with fever, cough, severe oral and ocular mucositis, and a disseminated rash lasting five days.
- Clinical diagnosis of MIRM was supported by the patient's presentation and laboratory confirmation of MP nucleic acid.
Findings:
- The patient received a comprehensive treatment including azithromycin, methylprednisolone, IVIG, and supportive care, later transitioned to doxycycline due to persistent MP nucleic acid positivity.
- Significant clinical improvement was observed within 14 days, with complete resolution of rash, mucosal lesions, and cough.
- Post-treatment follow-up confirmed MP nucleic acid clearance and normalized inflammatory markers.
Implications:
- MIRM represents a specific mucocutaneous reaction to MP infection that requires prompt recognition.
- Pediatricians must be aware of MIRM's clinical features to initiate timely, targeted interventions.
- Early diagnosis and management of MIRM can prevent severe complications and improve patient outcomes.
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