Treatment of Mycoplasma pneumoniae-Induced Rash and Mucositis With Cyclosporine

Abstract

Background Mycoplasma pneumoniae-induced rash and mucositis (MIRM) is a relatively newly recognized clinical entity that typically presents with predominant mucositis accompanied by variable cutaneous involvement 7-9 days after the onset of prodromal symptoms. There are no evidence-based guidelines for treatment, and current standards of care may include supportive therapy, antibiotics, corticosteroids, and intravenous immunoglobulin . Objective This case series aims to describe the potential efficacy of cyclosporine A (CsA) in the treatment of MIRM. Methods The present case series details our use of CsA early in the course of MIRM in 3 pediatric patients. Results Rapid clinical resolution was observed following CsA therapy. Conclusions We suggest that early initiation of CsA may be an effective therapeutic option for MIRM.

Pediatric SJS-TEN: Where are we now?

“…A second case report of TEN induced by MP responded rapidly with complete resolution within a week after a single dose of infliximab 5 mg/kg per day (the patient also received meropenem) 46 . A case series of three children whose MIRM was treated with cyclosporine suggests that the addition of cyclosporine 3 to 5 mg/kg per day for early cases may accelerate resolution compared with supportive care and antibiotics alone 58 .…”

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

“…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]. A recent case series of three patients with MIRM treated with cyclosporine A reported a statistically significant decrease in the overall length of hospital stay compared with supportive treatment in the literature [10].…”

“…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]. A recent case series of three patients with MIRM treated with cyclosporine A reported a statistically significant decrease in the overall length of hospital stay compared with supportive treatment in the literature [10]. Overall, patients suffering from MIRM tend to have longer hospital stays than patients suffering from EM alone and can require stays in the ICU or burn centers [3,5].…”

“…Classic MIRM includes clinical and laboratory evidence of atypical pneumonia caused by Mycoplasma with the following: two or more involved mucosal sites, less than 10% involved cutaneous surface area, few vesiculobullous lesions, or atypical scattered targets ± targetoid lesions. The two variants of MIRM coined were severe MIRM, which showed extensive involvement of atypical targetoid lesions or blisters, and MIRM sine rash, which showed minimal morbilliform lesions with few vesicles [3,5,10]. Interestingly, patients with MIRM sine rash had higher rates of mucosal involvement: oral (100%), ocular (92%), and urogenital (78%) [3,5].…”

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

“…Antibiotics directed against M pneumoniae are most commonly used, and some patients receive corticosteroids or less commonly intravenous immunoglobulin as an adjunct [ 3 , 19 ]. Cyclosporine has also been used for MIRM in a 3-patient case series with all patients quickly improving, although randomized controlled trials or larger studies are needed to further support efficacy [ 14 ]. Comprehensive supportive care is essential.…”