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Case: 5 year old presents to the ED with 2 weeks of fever. She has extensive cracked, bleeding lips and a rash on her hands and feet. She was recently diagnosed with “walking pneumonia” and hand, foot and mouth disease this week. Her pediatrician sent her in for further workup after she was found to have an elevated CRP on outpatient labs. A similar picture appears in the link below:
What's the diagnosis?
Answer
Answer: Mycoplasma pneumoniae-induced rash and mucositis
The diagnosis of Mycoplasma pneumonia-induced rash and mucositis (MIRM) was recently termed in the 2015 Journal of American Academy of Dermatology. It is characterized by mucocutaneous eruptions with prominent mucosal involvement. 94% of patients in the reviewed cases had extensive oral lesions that can range from erosions, ulcers or vesiculobullous lesions. 82% of patients had ocular involvement characterized by purulent bilateral conjunctivitis. In 63% of cases, patients were found to have urogenital lesions. Almost all of these patients had prodromal symptoms of cough and fever preceding the eruption by 1 week. The disease was found to be most prominent with young (11.9 ± 8.8 years) and with a 66% male predominance. The treatment is antibiotics such as azithromycin and oral corticosteroids with a minority of patients requiring IVIG. These patients have a good prognosis.
Bottom Line: Consider MIRM in patients with extensive mucosal disease that do not completely fit the criteria of Kawasaki’s or Stevens-Johnson Syndrome/ Toxic Epidermal Necrolysis.
Reference:
Canavan TN, Mathes EF, Frieden I, Shinkai K. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review. J Am Acad Dermatol. 2015
Feb;72(2):239-45.