19-year-old healthy male is evaluated in January in the emergency department after 3-day history of fever, dry cough, and newly developed nonpruritic rash.
Exam: He is febrile and tachycardic. Crackles appreciated on left side of chest and a macular, targetoid rash was present on his hands and feet including the palms and soles.
Chest radiograph showed infiltrates in the left lower lung field.
Over the next 48 hours mucositis developed involving the lips (pictured), buccal mucosa, conjunctivae and urethral meatus.
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Correct Answer: Mycoplasma pneumoniae
This case describes mycoplasma related skin lesions specifically – Mycoplasma Induced Rash and Mucositis (MIRM). Skin manifestations are one of the most common non-pulmonary complications of mycoplasma disease. MIRM is newly described entity that is an acute epidermolytic dermopathies and thus falls on the spectrum with erythema multiforme and Stevens-Johnson syndrome (SJS). At times the lesions or even pathology can mimic these diagnosis but there are a few distinguishing features.
- MIRM typically occurs in patients with respiratory involvement consistent with pneumonia
- MIRM has severe involvement of two or more mucosal sites, often with minimal skin involvement
- Prognosis significantly better for MIRM as compared with SJS
Treatment of MIRM is generally supportive care and typical course of appropriate antibiotic for mycoplasma pneumoniae -80-90% with full recovery.
Distractor answer choices
- Staphylococcal scalded skin syndrome would present as more diffuse skin involvement and erythema with bullae and skin desquamation particularly with friction.
- HSV and coxsackievirus are both infectious causes of erythema multiforme.
Written by Jeremey Walker at UAB
https://pubmed.ncbi.nlm.nih.gov/28830900/
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This question was uploaded on 2/25/22
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