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

Abstract

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 with vesicles, blisters and mild conjunctival hyperaemia (figure 1). Blood tests showed an increase in erythrocyte sedimentation rate (92 mm/hour; normal value <20 mm/hour) and in C reactive protein level (4.8 mg/dL; normal value <0.5 mg/dL), while white cell count was 12.7 x 10 ∧ 9/L (7 lymphocytes 7.2 x 10 ∧ 9/L, neutrophils 3.32 x 10 ∧ 9/L). In the following days, he developed preputial ulceration with painful micturition. QUESTION 1What is the most likely diagnosis? A. Erythema multiforme (EM) major. B. Herpetic gingivostomatitis. C. Antibiotic-induced Stevens-Johnson syndrome (SJS). D. Mycoplasma pneumoniae-induced rash and mucositis (MIRM). QUESTION 2 What test could confirm this diagnosis? A. Nasopharyngeal swab and virus PCR. B. Skin biopsy. C. Repeated serological assay and PCR for Mycoplasma pneumoniae (MP). D. None of the mentioned. QUESTION 3 What is the mainstay of management? A. IV corticosteroids B. IV Ig C. Supportive and topical therapy D.Antibiotic therapy Answers can be found on page 2.Figure 1 Vesicular oral lesions and conjunctivitis.