Mycoplasma-induced Rash and Mucositis: A Distinct Pediatric Entity from India

Mycoplasma-induced rash and mucositis (MIRM) is a recently recognized mucocutaneous disorder, often misdiagnosed as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), or erythema multiforme (EM). We report a 6-year-old boy presenting with fever, cough, and cold, followed by painful oral ulcerations, conjunctivitis, genital mucositis, and generalized vesiculobullous rash. He was on levetiracetam for a prior unprovoked seizure, raising suspicion of drug reaction. Initial differentials included SJS, TEN, EM, and Drug reaction with eosinophilia and systemic symptoms. Laboratory findings showed leukocytosis, thrombocytosis, and positive Mycoplasma pneumoniae Immunoglobulin M, while Herpes simplex virus polymerase chain reaction was negative. Histopathology revealed liquefactive necrosis with lymphohistiocytic infiltrates. Despite intravenous antibiotics, antivirals, and immunoglobulin, there was no improvement until pulse methylprednisolone was initiated. He was discharged on tapering oral steroids and doxycycline, with complete mucosal healing on follow-up. As there is no clear-cut distinction between histopathological findings of EM and MIRM, reporting biopsy changes whenever feasible is essential. Early recognition, targeted antibiotics, and timely immunomodulation are key to favorable outcomes.