Mucositis Secondary to Chlamydia pneumoniae Infection: Expanding the Mycoplasma pneumoniae–Induced Rash and Mucositis Concept

Abstract

The term Mycoplasma pneumoniae-induced rash and mucositis (MIRM) was recently proposed to identify the mucocutaneous condition secondary to M. pneumoniae infection that had historically been regarded among the more confusing pathologies of erythema multiforme and Stevens-Johnson syndrome. Based on a number of previous reports, these syndromes require differentiation since they have different prognoses and specific treatment requirements. We report a case of oral and genital erosions that strongly resembled MIRM without rash but were found to be secondary to a Chlamydia pneumoniae infection. After a thorough review of the literature on this subject, we propose that C. pneumoniae should also be considered a potential causative agent of MIRM and that this term should be amended to include C. pneumoniae infection.

Pediatric SJS-TEN: Where are we now?

“…Patients with MIRM have exactly the features of the previously noted patients who evaded classification; they have severe mucositis of multiple mucous membranes out of proportion to skin involvement, which typically is sparse but in some cases may be significant 14 . The characteristic constellation of features in MIRM is triggered by respiratory infection rather than medications, and pathogens other than MP have been reported 15 . Advances in technology, including respiratory polymerase chain reaction (PCR), have improved MP detection, and more specific methods to confirm infection have recently been developed 16 ; these include measurement of MP-specific antibody-secreting cells 17 .…”

Two pediatric cases of influenza B‐induced rash and mucositis: Stevens‐Johnson syndrome or expansion of the Mycoplasma pneumoniae‐induced rash with mucositis (MIRM) spectrum?

“…Ninety percent of patients will have erythema and erosion of the buccal, ocular, and genital mucosae, while 25% have respiratory tract or gastrointestinal involvement . In both of these cases, as in MIRM or chlamydia‐induced rash and mucositis, the patients presented with predominantly mucosal involvement, including ocular, buccal, lip, and genital mucosae . It has been suggested the MIRM may be associated with a milder, more protracted course.…”

“…18 In both of these cases, as in MIRM or chlamydia-induced rash and mucositis, the patients presented with predominantly mucosal involvement, including ocular, buccal, lip, and genital mucosae. 9 It has been suggested the MIRM may be associated with a milder, more protracted course. Influenza B-induced rash and mucositis may follow a similar course.…”

“…2-8 More recentlyMycoplasma pneumoniae-associated rash and mucositis (MIRM) has replaced the previous M. pneumoniae-induced SJS nomenclature, and other infectious etiologies have been described. 9 In this report, we describe two cases of recurrent rash and mucositis in pediatric patients presenting with predominantly mucosal involvement in association with influenza B infection, both in patients with prior episodes of SJS presumed to be due to M. pneumoniae.…”

Chlamydia pneumonia – induced mucositis

“…Unlike MIRM, chlamydia-induced mucositis is not a labeled condition, not well known, and believed to be underreported. In a recent review by Mayor-Ibarguren et al, 2 the authors found 21 reported cases of C. pneumoniae-related mucositis/EM/SJS in the medical literature. Interestingly, it has been reported that these cases presented in a similar manner like MIRM with fever and respiratory symptoms and mucous membrane or skin involvement.…”