Mycoplasma pneumoniae and mucositis - part of the Stevens-Johnson syndrome spectrum.
Meyer Sauteur, Patrick M. 1,2; Goetschel, Philippe 1; Lautenschlager, Stephan 3
[Article] Journal der Deutschen Dermatologischen Gesellschaft. 10(10):740-746, October 2012.

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Background: Mycoplasma pneumoniae: may induce mucosal inflammation, referred to as M. pneumoniae-associated mucositis (MPAM). There is no generally accepted definition of MPAM, since there may be mucosal lesions only, or mucosal and minimal skin lesions.

Patients and Methods: We conducted a literature review of MPAM, paying particular attention to pathogenesis, clinical manifestations, treatment decisions, and prognosis.

Results: We identified 32 cases of MPAM (median age 13.5 years), whereof 23 patients were otherwise healthy children and young adolescents (72 %). M. pneumoniae infection was associated with fever and respiratory symptoms in all calls; it was confirmed by serology (n = 30) and/or PCR (n = 9). Oral lesions were present in all cases, followed by ocular (97 %) and uro-genital lesions (78 %). Despite the syndrome's name postulating the absence of cutaneous involvement, minimal skin lesions occurred in 31 %. Treatment regimens included systemic antibiotics (100 %) and systemic anti-inflammatory treatment with corticosteroids (31 %) or immunoglobulins (9 %). Macrolides were given in 81 %, with failure, relapse, and/or worsening in one-third of patients. No patient suffered long-term sequelae.

Conclusion: MPAM is a distinct extra-pulmonary manifestation falling into the continuum of Stevens-Johnson syndrome. This entity may be due to inflammatory mechanisms suggesting that systemic anti-inflammatory treatment is even more important than antimicrobials.

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