Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM?

Abstract

Introduction A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM. Case Presentation A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered. Discussion Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient’s symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.

Mucosal Respiratory Syndrome: A Systematic Literature Review

“…Fifteen reports detailing 16 cases were excluded because mucositis was associated with skin lesions covering more than 1% of the skin surface or with target skin lesions. Ultimately, 57 articles were retained for analysis [ 5 , 6 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. They had been published between 1945 and 2020 in English ( n = 50), Spanish ( n = 3), Danish ( n = 2), French ( n = 1), and Italian ( n = 1).…”

“…The laboratory diagnosis of M. pneumoniae infection was made in 53 and that of C. pneumoniae infection in 5 cases [ 6 , 41 , 55 , 62 , 63 ]. The diagnosis of M. pneumoniae infection ( n = 53) was made by means of a relevant rise in immunoglobulin G titer in paired blood samples ( n = 26), a positive mycoplasma testing in a respiratory tract sample ( n = 15), or both a relevant rise in immunoglobulin G titer and a positive mycoplasma testing ( n = 10).…”

Mycoplasma pneumoniae-Induced Rash and Mucositis in a Previously Healthy Man: A Case Report and Brief Review of the Literature

“…In addition, there has been debate in the pediatric literature as to whether the term “reactive infectious mucocutaneous eruption” (RIME) better describes MIRM given the fact that other pathogens including Chlamydophila pneumoniae ( Chlamydia pneumoniae ) and viral pathogens, including influenza B, may induce a similar constellation of symptoms [ 11 , 12 , 20 , 26 , 29 ].…”

Clinical features of recurrent Mycoplasma pneumoniae–induced rash and mucositis

“…Severe complications include scarring, prolonged hospitalization, ICU admission, recurrence, and, rarely, death. 2 Recently, the term reactive infectious mucocutaneous eruption (RIME) has emerged to include a broader spectrum of pathogens, including Chlamydophila pneumoniae 4 and influenza B, 5 that can work alone or in conjunction with Mp to cause mucocutaneous disease. [5][6][7] One review article denoted MIRM as a particular type of parainfectious eruption within the larger category of RIME and the most precise term when Mp induces the disease.…”

“…ther evidence for this pattern, as coinfection with Mp and non-Mp pathogens in both of the patient's recurrences resulted in eruption over a single mucous membrane 6. Complicating the diagnosis and identification of recurrent MIRM is the recognition that multiple other pathogens have been attributed in rare cases to cause mucocutaneous disease similar to MIRM, including Chlamydophila pneumoniae,4 influenza B,7 and SARS-CoV-2 15. Although one of our isolated MIRM patients had evidence of coin-fection with both Mp and Chlamydophila pneumoniae at the time of their hospitalization, none of the 25 other episodes in this study had evidence of other pathogens contributing.…”