Mycoplasma-induced rash and mucositis in a young patient with red eyes, oral mucositis, and targetoid cutaneous vesicles

Sandhu, Rikinder; Mareddy, Chinmaya; Itskowitz, Marc S.; Mount, Charles E.; Bhanot, Nitin; Min, Zaw

doi:10.1016/s1473-3099(16)30515-1

Cited by 6 publications

(4 citation statements)

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“…Paciente con eritema conjuntival y queilitis con exantema vesículo-ampolloso en tronco. 2022; 43 (5) de autores con inmunoglobulinas y corticoides sistémicos; 1,8 sin embargo, se han reportado casos autolimitados que no precisaron tratamiento.…”

Section: Discussionunclassified

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Exantema mucocutáneo inducido por Mycoplasma pneumoniae en pediatría

et al. 2022

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INTRODUCCIÓN: El exantema mucocutáneo inducido por Mycoplasma (EMIM) es una entidad separada del síndrome de Stevens-Johnson(SSJ) y el eritema multiforme (EM), descrita principalmente en adolescentes y en la que predomina la afectación mucosa sobre la cutánea.OBJETIVO: Describir nuestra experiencia en pacientes pediátricos afectos de EMIM.MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo en menores de 14 años con EMIM entre 2015 - 2020.RESULTADOS: Se diagnosticaron 6 pacientes, agrupándose 5 entre enero-abril de 2019. En 5 casos hubo afectación de mucosa ocular, faríngea y urogenital. Las lesiones cutáneas vesículo-ampollosas fueron las predominantes. En todos se aisló M.pneumoniae. Debido a la afectación mucosa, 4 pacientes precisaron nutrición parenteral y 3 sondaje urinario. En 5 se prescribió tratamiento inmunomodulador con corticoides sistémico e inmunoglobulina intravenosa. La evolución fue favorable y la secuela más frecuente fue la xeroftalmia.CONCLUSIÓN: A pesar de la similitud clínica del EMIM con el SSJ y el EM, debemos sospecharlo en adolescentes con predominio de afectación mucosa. La evolución de nuestros pacientes fue favorable con tratamiento de soporte e inmunomodulador. Son necesarios estudios bien diseñados para establecer que pacientes se benefician de tratamiento con corticoides y/o inmunoglobulina.

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Section: Discussionunclassified

“…Por todas estas razones ha sido definido en la bibliografía como un síndrome clínico diferenciado. [1][2][3][4][5] En 2015 Canavan y cols. realizaron un metaanálisis en el que se analizaron las características clínico-epidemiológicas y pronósticos de 202 pacientes con diagnóstico de EMIM.…”

Section: Introductionunclassified

Exantema mucocutáneo inducido por Mycoplasma pneumoniae en pediatría

et al. 2022

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“…Based on the observed clinical pattern, they proposed that mucocutaneous disease in the context of Mp infection constitutes a syndrome different from EM and SJS/TEN, and suggested the term Mycoplasma pneumoniae-induced rash and mucositis (MIRM) [15]. The concept of MIRM as a separate entity has since been adopted by different authors [16][17][18][19][20][21]. However, the concept has been rejected by others [3] and so far, there is no consensus on MIRM as a separate entity, nor has this concept been validated in further studies.…”

Section: Introductionmentioning

confidence: 99%

Clonal expansion of CD4+CD8+ T cells in an adult patient with Mycoplasma pneumoniae-associated Erythema multiforme majus

Volkers

Meisel

Terhorst‐Molawi

et al. 2021

Allergy Asthma Clin Immunol

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Background Erythema multiforme (EM) is an acute, immune-mediated mucocutaneous disease, most often preceded by herpes simplex virus (HSV) infection or reactivation. Mycoplasma pneumoniae (Mp) is considered the second major trigger of EM and is often associated with an atypical and more severe presentation of disease, characterized by prominent mucosal involvement. However, contrary to HSV-associated Erythema multiforme (HAEM), immunological mechanisms of Mp-associated EM remain unclear. Case presentation We present the case of a 50-year-old male patient presenting with community-acquired pneumonia (CAP) and erythema multiforme majus (EMM). Acute Mp infection was diagnosed by seroconversion, with no evidence of HSV infection as a cause of EMM. We performed immune phenotyping of blister fluid (BF) and peripheral blood (PB) T cells and detected a clonally expanded TCRVβ2+ T cell population that was double positive for CD4 and CD8, and expressed the cytotoxic markers granulysin and perforin. This CD4+CD8+ population comprised up to 50.7% of BF T cells and 24.9% of PB T cells. Two years prior to the onset of disease, the frequency of PB CD4+CD8+T cells had been within normal range and it gradually returned to baseline levels with the resolution of symptoms, suggesting an involvement of this population in EMM disease pathophysiology. Conclusions This report is the first to provide a phenotypic description of lesional T cells in Mp-associated EMM. Characterizing the local immune response might help to address pathophysiological questions and warrants further systematic research.

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“…MIRM is traditionally diagnosed after the eruption of mucocutaneous lesions, and initial workup generally starts in the emergency department for pulmonary symptoms. A chest X-ray can reveal any type of atypical lung pattern including reticulonodular densities, interstitial infiltrates, and lobar consolidation [7][8][9]. Patients can also have elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and leukocytosis with left shift [3,4,6,7].…”

Section: Introductionmentioning

confidence: 99%