Erythema Bullous Multiforme: A Complication of Mycoplasma pneumoniae Infection
A
12-year-old boy was admitted to the hospital with fever, cough, rales, and annular skin lesions. During the hospitalization, the patient’s skin lesions became bullous and the patient developed necrotic mucosa lesions (Figures 1 and 2). Lobar pneumonia was detected on chest radiography. Treatment was initially started with a cephalosporin but was subsequently changed to a macrolide when the results from a Mycoplasma pneumoniae polymerase chain reaction were positive. Erythema bullous multiforme was the clinical diagnosis, and the patient was treated with corticosteroids and intravenous immunoglobulins. The patient improved clinically and was discharged after resolution of the skin lesions. M pneumoniae is a well-known cause of childhood pneumonia. Known extrapulmonary complications are dermatologic, neurologic, and hematologic. Nonrespiratory illness is generally due to autoimmune mechanisms. Dermatologic manifestations such as exanthematous skin eruptions, erythema nodosum, urticaria, and Stevens-Johnson syndrome (SJS) may occur in 25% to 33% of patients.1 Erythema bullous multiforme is considered to be in the spectrum of disease that includes SJS but, unlike SJS, there is little morbidity and no mortality reported.2 Hypotheses exist that immune complex–mediated vascular injury, cell-mediated immune response/cytotoxic injury to epithelial cells, and autoimmune
Figure 2. Necrotic mucosa lesions on mouth, tongue, and lips.
mechanisms may be responsible. The specific dermatologic manifestations of MP need to be recognized and considered in the differential diagnosis of mucocutaneous lesions. n Nathalie Rock, MD Dominique Belli, MD Nadia Bajwa, MD Department of General Pediatrics University Hospitals of Geneva Geneva, Switzerland
References 1. Schalock PC, Dinulos JGH. Mycoplasma pneumoniae-induced cutaneous disease. Int J Dermatol 2009;48:673-80. 2. Schalock PC, Dinulos JGH, Pace N, Schwarzenberger K, Wenger JK. Erythema multiforme due to Mycoplasma pneumoniae infection in two children. Pediatr Dermatol 2006;23:546-55.
Figure 1. Annular skin lesions becoming progressively bullous leading to diagnosis of erythema bullous multiforme in a patient infected by mycoplasma pneumoniae.
J Pediatr 2014;164:421. 0022-3476/$ - see front matter. Copyright ª 2014 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.10.014
421
A
12-year-old boy was admitted to the hospital with fever, cough, rales, and annular skin lesions. During the hospitalization, the patient’s skin lesions became bullous and the patient developed necrotic mucosa lesions (Figures 1 and 2). Lobar pneumonia was detected on chest radiography. Treatment was initially started with a cephalosporin but was subsequently changed to a macrolide when the results from a Mycoplasma pneumoniae polymerase chain reaction were positive. Erythema bullous multiforme was the clinical diagnosis, and the patient was treated with corticosteroids and intravenous immunoglobulins. The patient improved clinically and was discharged after resolution of the skin lesions. M pneumoniae is a well-known cause of childhood pneumonia. Known extrapulmonary complications are dermatologic, neurologic, and hematologic. Nonrespiratory illness is generally due to autoimmune mechanisms. Dermatologic manifestations such as exanthematous skin eruptions, erythema nodosum, urticaria, and Stevens-Johnson syndrome (SJS) may occur in 25% to 33% of patients.1 Erythema bullous multiforme is considered to be in the spectrum of disease that includes SJS but, unlike SJS, there is little morbidity and no mortality reported.2 Hypotheses exist that immune complex–mediated vascular injury, cell-mediated immune response/cytotoxic injury to epithelial cells, and autoimmune
Figure 2. Necrotic mucosa lesions on mouth, tongue, and lips.
mechanisms may be responsible. The specific dermatologic manifestations of MP need to be recognized and considered in the differential diagnosis of mucocutaneous lesions. n Nathalie Rock, MD Dominique Belli, MD Nadia Bajwa, MD Department of General Pediatrics University Hospitals of Geneva Geneva, Switzerland
References 1. Schalock PC, Dinulos JGH. Mycoplasma pneumoniae-induced cutaneous disease. Int J Dermatol 2009;48:673-80. 2. Schalock PC, Dinulos JGH, Pace N, Schwarzenberger K, Wenger JK. Erythema multiforme due to Mycoplasma pneumoniae infection in two children. Pediatr Dermatol 2006;23:546-55.
Figure 1. Annular skin lesions becoming progressively bullous leading to diagnosis of erythema bullous multiforme in a patient infected by mycoplasma pneumoniae.
J Pediatr 2014;164:421. 0022-3476/$ - see front matter. Copyright ª 2014 Mosby Inc. All rights reserved. http://dx.doi.org/10.1016/j.jpeds.2013.10.014
421
