Mycoplasma pneumoniae-associated Mucositis: A Recently Described Entity

Abstract

Mycoplasma pneumoniae (MP) is a common cause of respiratory infections and can be associated with extrapulmonary complications. MP mucositis has recently been described as a distinct endemic clinical entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM). The authors present the case of a 46-year-old man with atypical pneumonia associated with exuberant mucositis, conjunctival hyperaemia and positive serological assays for MP IgM. The patient was treated with azithromycin and systemic corticosteroid therapy. Supportive care including pain management, intravenous hydration and mucosal care was also given. There was complete resolution of the pneumonia and mucositis. The presence of atypical pneumonia with mucosal involvement without cutaneous lesions and a favourable clinical evolution led to the diagnosis of MIRM.LEARNING POINTSMycoplasma pneumoniae infection can be associated with mucocutaneous lesions. A new entity called Mycoplasma pneumoniae-induced rash and mucositis (MIRM) has been recently described. The mucocutaneous involvement associated with MIRM is predominantly mucositis with scarce or absent cutaneous expression.The clinical presentation, pathophysiology and disease outcomes of MIRM distinguish it from Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiform.MIRM has an overall favourable prognosis as the majority of patients recover without sequalae and recurrence is rare.

Mycoplasma Pneumoniae Induced Rash and Mucositis with Bilateral Otitis Media and Sinusitis

“…This reinforces the need for prompt otolaryngologic evaluation in patients suffering from epistaxis as well as otitis media with tympanic membrane rupture. The patient was treated with supportive management, the mainstay of which includes appropriate pain management, intravenous hydration, and mucosal care [3,[5][6][7]. Two of the largest reviews of the literature indicate that 80% of MIRM patients were treated with antibiotics, 31-35% were treated with corticosteroids, 8-9% were treated with intravenous IGs (IVIG), and one patient was treated with plasmapheresis [3][4][5][6]10].…”

“…The primary reported theory suggests cloning of B cells with cutaneous immune complex deposition and complement formation leading to localized inflammation and destruction. Molecular mimicry between Mycoplasma adhesion molecules and keratinocyte antigen has also been proposed [3][4][5][6][7].…”

“…Most patients suffering from MIRM are pediatric males, as seen in the emergency department for generalized and pulmonary symptoms, who then further develop cutaneous complications. It appears that these patients have 7 to 10 days of prodromal fever, malaise, and cough before mucocutaneous eruption [3,[5][6][7]. Canavan et al noted sparse cutaneous involvement in 47% of patients compared with severe mucositis alone (34%) and moderate cutaneous involvement alone (19%).…”

“…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].…”

“…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]. Serologic testing for identification can include cold agglutinins, polymerase chain reaction (PCR), enzyme-linked immunoassays (ELISA), and MP immunoglobulin (Ig) M antibody levels ].…”