Oral Ulcerations after Respiratory Symptoms

Background/Objective: Mycoplasma pneumoniae is frequently associated with respiratory infections in pediatric patients, but can also cause mucosal and cutaneous lesions. It has a wide spectrum of manifestations including Kawasaki disease, erythema multiforme, Steven-Johnson Syndrome (SJS), toxic epidermal necrolysis and Mycoplasma pneumoniae induced rash and mucositis (MIRM). The authors’ objective was to illustrate two possible presentations of MIRM.

Case description:

Case 1: Female, 15-years-old, was admitted to the emergency room with diffuse ulcerations of the oral mucosa (lips, palate and gums) partially covered by hemorrhagic crusts, as well as conjunctiva’s erythema. During the previous month, she presented nasal obstruction, rhinorrhea and cough. No fever and no cutaneous involvement. Complementary exams included a chest X-ray consistent with an atypical pneumonia, negative DNA protein chain reaction but the serum enzyme immunoassay revealed a positive M. pneumoniae IgM.

Case 2: Male 17-years-old, presented to the emergency room with a 7-days history of fever, cough and rhinorrhea. One day before to the admission, he developed edema and painful erosions of the oral mucosa, purulent bilateral conjunctivitis and minor urethral meatus erythema. Absence of cutaneous involvement. Chest X-ray was consistent with an atypical pneumonia and the DNA protein chain reaction was positive for M. pneumoniae; the enzyme immunoassay is in progress.

Both were treated with a 3-days azithromycin and supportive care and pain management. Following presented a noticeable clinical improvement and favorable prognosis.

Discussion/Conclusion: The MIRM was described as a new entity with mucosal findings consistent with SJS, but without or sparse cutaneous involvement, preceded by a recognized M. pneumoniae infection. These cases evidence clinical and diagnostic features previously described in MIRM which include a predominance of two or more mucosal sites, relatively sparse cutaneous involvement and evidence of an atypical infection. An accurate diagnosis is of utmost importance for the correct management and prognosis.