Stevens-Johnson Syndrome, Caused by Mycoplasma, Presenting without Skin Involvement

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Journal of Investigative Medicine





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Purpose of study Mycoplasma pneumoniae is an obligate intracellular bacteria which is typically associated with pulmonary infections. Although Mycoplasma pneumonia is usually self-limited and mild, it has been associated with numerous extra-pulmonary manifestations such as maculopapular rashes, hemolytic anaemia, and myocarditis. Rarely it has been known to cause Stevens-Johnson syndrome (SJS) which is considered an autoimmune T-cell mediated condition. While SJS in its classical form causes sloughing lesions in both skin and mucous membrane, we report 3 cases of SJS without any skin involvement. Methods used Chart review and literature review were the primary methods utilised for this abstract. Summary of results We report 3 male patients between ages 12 and 13 years who presented with erythematous painful sores in their mouth. The lesions had an acute onset and have been progressive in nature. While 2 of the patients were from Las Vegas, one was visiting Las Vegas from Turkey. All three reported symptoms of mild upper respiratory infection such as nasal congestion, fatigue and subjective fever but only one of the patients had any recent antibiotic exposure. One of the patient’s lesions were severe enough to warrant total parenteral nutrition due to poor oral intake. No skin lesions were noted in any of these patients. All three patients had serological evidence of M. pneumoniae infection. The patients were diagnosed with SJS without any skin involvement and two were given a short course of intravenous steroid after which they improved significantly. Conclusions The association between M. pneumoniae and SJS has been well established over the years. In addition, there are literature reports of SJS presenting without skin involvement. The question of whether this is a separate entity (Fuchs syndrome) or a forme fruste of SJS has not been convincingly answered yet. We present 3 cases of such presentation associated with serological evidence for M. pneumoniae infection in children. Although self-limited in our patients, the severity of the clinical condition and the resultant anxiety to the families makes it important to establish the aetiology in these situations. We conclude that Mycoplasma induced SJS may present without the typical skin lesions but mucosal lesions only.


Diagnosis | Medicine and Health Sciences



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