1
|
Blohm ME, Ebenebe CU, Rau C, Escherich C, Johannsen J, Escherich G, Driemeyer J, Nagel PD, Kobbe R, Lütgehetmann M, Lennartz M, Booken N, Schneider SW, Singer D. Mucha-Habermann disease: a pediatric case report and proposal of a risk score. Int J Dermatol 2021; 61:401-409. [PMID: 34287852 DOI: 10.1111/ijd.15770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/31/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022]
Abstract
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD) is a rare inflammatory dermatological disease. A case of a 13-year-old boy with FUMHD possibly triggered by mycoplasma infection is presented. Based on FUMHD cases identified in a MEDLINE literature search, demographic, treatment, and outcome data were analyzed. An FUMHD mortality risk score is proposed based on the likelihood ratios of risk factors for a fatal outcome. Our FUMHD case had marked leukopenia and thrombocytopenia at admission. He recovered without systemic immunosuppressive treatment. Literature review revealed 119 FUMHD cases. Overall lethality was 14/119 (12%, CI 6-17%), and lethality in children was lower (1/54, 2%, CI 0-6%) compared to adults (13/65, 20%, CI 11-31%). Risk factors for a fatal outcome (likelihood ratio; P) were sepsis (24.97, P < 0.001), adult vs. pediatric patient age (11.19; P = 0.001), systemic involvement (19.97, P < 0.001), and mucosal involvement (4.58; P = 0.032). The proposed FUMHD mortality risk score = Age/10 + 4 + 4 (if systemic involvement) + 1 (if mucosal involvement) was discriminative (sensitivity 93%, specificity 77%). In FUMHD, immune-suppressive treatment intensity should be balanced against the mortality risk, as infectious complications are a frequent cause of death.
Collapse
Affiliation(s)
- Martin Ernst Blohm
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Chinedu Ulrich Ebenebe
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Cornelius Rau
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin Escherich
- Department of Paediatric Oncology, Haematology and Clinical Immunology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jessika Johannsen
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Escherich
- Department of Paediatric Haematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joenna Driemeyer
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Daniel Nagel
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robin Kobbe
- Division of Infectious Diseases, First Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Booken
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Werner Schneider
- Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Department of Paediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Division of Neonatology and Paediatric Intensive Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|