Skin in the spectrum of mycoplasma infections

How to cite this article:
Gude D, Bansal DP. Skin in the spectrum of mycoplasma infections. Ann Trop Med Public Health 2011;4:151-2

 

How to cite this URL:
Gude D, Bansal DP. Skin in the spectrum of mycoplasma infections. Ann Trop Med Public Health [serial online] 2011 [cited 2017 Nov 14];4:151-2. Available from: https://www.atmph.org/text.asp?2011/4/2/151/85780

Sir,

Cutaneous manifestations of mycoplasma although well documented (with an incidence of 25-33%) are usually not well heeded by clinicians. We report the case of a 12-year-old male who presented with a history of cough (scant productive) and fever with chills and rigors for the past 10 days. He developed itchy, erythematous rash predominantly on the trunk in the last 2 days. He was afebrile and hemodynamically stable. Generalized, pruritic urticaria-like exanthem with raised erythematous plaques were noted on the trunk [Figure 1]. Examination findings including auscultation of the lungs were normal. Computed tomography chest showed multiple patchy areas of consolidation distributed in both lungs suggesting bronchopneumonia [Figure 2]. Laboratory tests showed hemoglobin of 12 g/ dL; TLC (Total leukocyte count) of 6,300/mm 3 ; and ESR (Erythrocyte Sedimentation Rate) of 80 mm/h. Sputum gram stain, culture sensitivity, and AFB (Acid Fast Bacilli) were negative. Serology for Mycoplasma pneumoniae (MP) IgM was positive at 2.18 U/L (IgG negative). Diagnosis of atypical pneumonia with extrapulmonary (cutaneous) manifestations was made and clarithromycin (15 mg/kg/day divided every 12 h for 10 days) was administered. Patient improved (cutaneous and radiological) over the course.

Figure 1: Urticaria-like exanthem with raised erythematous plaques on the trunk

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Figure 2: Computed tomography chest showing multiple patchy areas of consolidation distributed in both lungs suggesting bronchopneumonia

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A school of thought classifies the extrapulmonary manifestations due to MP infection into three categories: A direct type in which inflammatory cytokines locally induced by lipoproteins contained in the bacterial cell membrane play a role; an indirect type in which immune modulation occurs, such as autoimmunity through cross-reaction between the bacterial cell components and human cells; and a vascular occlusion type in which vasculitis and/or thrombosis with or without systemic hypercoagulable state induced by the bacterium may mediate. [1] One-third of acute childhood urticaria leading to hospitalization may be related to MP infection implying that urticaria refractory to antihistamine treatment and abstinence from allergens should seek serologic examinations for MP. [2] Three patients from a single family infected with MP sported three disparate cutaneous manifestations such as erythema nodosum, anaphylactoid purpura, and acute urticaria, respectively. [3] The immaturity of the adaptive immunity of a host may explain the age-related variations in cutaneous manifestations of MP infections. The skin involvement in MP infection can occur before, during, or after the appearance of respiratory symptoms or even without them.

Bullous erythema multiforme secondary to MP may have a distinct and better prognosis compared with the more serious end of the spectrum-mucositis and  Stevens-Johnson syndrome More Details. Non-episodic angioedema with eosinophilia including fever, weight gain, and elevated serum IgM may be preceded by or in fact triggered by MP infection with dermatological manifestation. [4] Fuchs syndrome, a variant of erythema multiforme predominantly involving the mucosal surfaces (erythema, erosions, and ulcerations of the oral or rarely genital mucosa and severe conjunctivitis) with sparing of the skin, may pose a diagnostic challenge and has evidence that MP is one of the etiological factors. [5]

Awareness about the cutaneous spectrum of MP manifestations is of paramount importance because of the usually treatable nature of the entity, and hence high index of clinical suspicion is warranted when dealing with such presentations.

Acknowledgement

We thank our colleagues and staff of Internal Medicine and Critical Care for their support.

References

 

1. Narita M. Pathogenesis of extrapulmonary manifestations of Mycoplasma pneumoniae infection with special reference to pneumonia. J Infect Chemother 2010;16:162-9.
2. Wu CC, Kuo HC, Yu HR, Wang L, Yang KD. Association of acute urticaria with Mycoplasma pneumoniae infection in hospitalized children. Ann Allergy Asthma Immunol 2009;103:134-9.
3. Kano Y, Mitsuyama Y, Hirahara K, Shiohara T. Mycoplasma pneumoniae infection-induced erythema nodosum, anaphylactoid purpura, and acute urticaria in 3 people in a single family. J Am Acad Dermatol 2007;57 (2 Suppl):S33-5.
4. Stockner I, Thaler J, Fichtel G, Egarter-Vigl E, Wallnöfer W, Wiedermann CJ. Non-episodic angioedema associated with eosinophilia following Mycoplasma pneumoniae infection. Clin Rheumatol 2008;27:1573-6.
5. Havliza K, Jakob A, Rompel R. Erythema multiforme majus (Fuchs syndrome) associated with Mycoplasma pneumoniae infection in two patients. J Dtsch Dermatol Ges 2009;7:445-8.

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/1755-6783.85780

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