Oral ulcerations after respiratory symptoms

Abstract

Mycoplasma pneumoniae (M. 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, Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis and M. pneumoniae-induced rash and mucositis (MIRM). This last condition was described as a new entity with mucosal findings consistent with SJS, but without or with sparse cutaneous involvement, preceded by a recognized M. pneumoniae infection. The main objective was to describe two possible presentations of this MIRM in order to raise awareness of the diagnostic criteria and proper clinical approach. Authors report the cases of two adolescents with mucosal but no cutaneous involvement that had laboratory confirmation of M. pneumoniae infection, either with DNA protein chain reaction or serum enzyme immunoassay. The therapeutic approach included azithromycin course and supportive care, with noticeable clinical improvement and favorable prognosis. These cases corroborate clinical and diagnostic features previously described, which include a predominance of two or more mucosal sites (mainly oral and ocular), relatively sparse cutaneous involvement and evidence of an atypical infection. An accurate diagnosis is of utmost importance for the correct management and prognosis.