Recurrent mycoplasma pneumoniae infection associated with a different type of mucocutaneous disease

Abstract

An 8-year-old boy developed Stevens-Johnson syndrome (SJS) secondary to Mycoplasma pneumoniae (MP) infection. He had fever, cough, severe erosions involving the conjunctivae, genitals, and lips, as well as a few erythematous macules and blisters. He was treated with steroid pulse therapy twice and intravenous immunoglobulin. The following year, he became infected with MP again. He exhibited fever, cough, generalized erythema-like scarlet fever, which resolved over several days with topical corticosteroid, and only slight erosion on the genitalia. Although there are a few reports of recurrent SJS or erythema multiforme due to MP, this case is very rare because recurrent MP infection was associated with a different mucocutaneous disease, SJS with severe mucositis and rash-like scarlet fever. MP is likely underestimated as a cause of mucocutaneous diseases with atypical symptoms, recurrent episodes, or without respiratory symptoms. We recommend that further studies on MP infection be conducted. The pathomechanisms of dermatological manifestations due to MP infection are generally considered immunological in nature. This case suggests that the pathomechanisms involve other factors such as potential genetic predisposition and inammatory cytokine production from bacterial strains.