A case report of a successfully treated Mycoplasma-Induced Rash and Mucositis (MIRM) in a 10-year-old Filipino

ABSTRACT

@#Introduction: Erythema multiforme has been known as an infection or drug-associated mucocutaneous eruption characterized by target lesions. A clinical entity, known as Mycoplasma-induced rash and mucositis seen mostly in the pediatric population is emerging and may be associated with atypical pneumonia caused by Mycoplasma pneumoniae. This presents with features overlapping with erythema multiforme and SJS-TEN spectrum but with a different trigger, prognosis, and recurrence rate. Case summary: Target lesions in the clinical setting are usually characteristically associated with erythema multiforme, a mucocutaneous condition associated with an underlying infectious trigger. We present a case of a 10-year-old Filipino boy who was initially diagnosed with erythema multiforme major. Eventual testing for the etiology of the underlying infection, Mycoplasma pneumoniae, proved to be a useful diagnostic that gave a better grasp on the case’s mechanism, sequela, and prognosis. The patient was admitted for pneumonia and his presenting mucositis was severe. Cutaneously, he had atypical target and few target lesions on the trunk and extremities. He was diagnosed as a case of Mycoplasma-induced rash and mucositis (MIRM) and treated with antibiotics and systemic steroids for which he recovered fully in three weeks. MIRM should be separated from erythema multiforme, Stevens Johnsons syndrome and toxic epidermal necrolysis as it follows a different disease course. Conclusion: Mycoplasma-induced rash and mucositis is now considered a distinct entity despite it having overlapping features with erythema multiforme and SJS-TEN spectrum. It presents usually in the younger age group with absent to sparse atypical vesiculobullous or targetoid lesions, significant mucosal involvement, and confluent necrosis on histology. It is important to identify it as a trigger because of its more frequent and severe mucosal sequelae. Management includes symptomatic relief, antibiotic therapy with a macrolide in the presence of pneumonia and systemic steroids when mucositis is severe. Majority of patients achieve full recovery.