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Gholap RS, Engelmann AR, Munir WM. Chlamydia psittaci -Induced Reactive Infectious Mucocutaneous Eruption With Ocular Involvement. Eye Contact Lens 2023; 49:572-574. [PMID: 37728867 DOI: 10.1097/icl.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/21/2023]
Abstract
INTRODUCTION This report highlights a postinfectious mucocutaneous inflammatory response involving the ocular surface and adnexa after Chlamydophila psittaci exposure. CASE DESCRIPTION A 35-year-old man presented after a prodrome of upper respiratory symptoms with rash and mucocutaneous blistering involving the ocular and oral mucosa, causing pseudomembranous conjunctivitis and corneal epithelial defects. Extensive inflammatory and infectious workup suggested recent C. psittaci infection. The patient was treated with doxycycline and supportive therapy, whereas the ocular surface was treated with lubrication and prophylactic antibiotics. In follow-up, he has retained excellent visual acuity but required scleral contact lenses to control ocular surface symptoms because of fibrotic changes of the marginal conjunctiva. DISCUSSION Such blistering inflammation has most commonly been described after pediatric respiratory infections because of Mycoplasma pneumoniae with additional instances related to Chlamydia pneumoniae , Epstein-Barr virus, influenza B, and other stimuli . To the best of our knowledge, this is the first reported case of C. psittaci- induced reactive infectious mucocutaneous eruption (RIME). RIME is a rare parainfectious inflammatory condition with sequelae frequently involving the periocular mucosa. Although systemic and nonocular adverse outcomes in this condition tend to be self-limited, the impact on the ocular surface may be severe, and the consequences to vision may be ongoing, especially if not treated aggressively at the outset.
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Affiliation(s)
- Radhika S Gholap
- School of Medicine (R.S.G.), University of Maryland, Baltimore, MD; and Department of Ophthalmology and Visual Sciences (A.R.E., W.M.M.), University of Maryland, Baltimore, MD
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De Luigi G, Meoli M, Zgraggen L, Kottanattu L, Simonetti GD, Terrani I, Bianchetti MG, Lava SA, Milani GP. Mucosal Respiratory Syndrome: A Systematic Literature Review. Dermatology 2021; 238:53-59. [PMID: 33774629 PMCID: PMC8089407 DOI: 10.1159/000514815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/25/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Mycoplasma pneumoniae atypical pneumonia is frequently associated with erythema multiforme. Occasionally, a mycoplasma infection does not trigger any cutaneous but exclusively mucosal lesions. The term mucosal respiratory syndrome is employed to denote the latter condition. Available reviews do not address the possible association of mucosal respiratory syndrome with further atypical bacterial pathogens such as Chlamydophila pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Francisella tularensis, or Legionella species. We therefore performed a systematic review of the literature addressing this issue in the National Library of Medicine, Excerpta Medica, and Web of Science databases. SUMMARY We found 63 patients (≤18 years, n = 36; >18 years, n = 27; 54 males and 9 females) affected by a mucosal respiratory syndrome. Fifty-three cases were temporally associated with a M. pneumoniae and 5 with a C. pneumoniae infection. No cases temporally associated with C. psittaci, C. burnetii, F. tularensis, or Legionella species infection were found. Two cases were temporally associated with Epstein-Barr virus or influenzavirus B, respectively.
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Affiliation(s)
| | - Martina Meoli
- Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Lisa Kottanattu
- Università della Svizzera Italiana, Lugano, Switzerland
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Giacomo D. Simonetti
- Università della Svizzera Italiana, Lugano, Switzerland
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - Isabella Terrani
- Department of Dermatology Ente Ospedaliero Cantonale, Ospedale Regionale di Lugano, Lugano, Switzerland
| | | | - Sebastiano A.G. Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Gregorio P. Milani
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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Umapathi KK, Tuli J, Menon S. Chlamydia pneumonia - induced mucositis. Pediatr Neonatol 2019; 60:697-698. [PMID: 31239206 DOI: 10.1016/j.pedneo.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
| | - Jagdeep Tuli
- Metro Health Medical Center - Case Western Reserve University, Cleveland, OH, USA
| | - Sruthi Menon
- Metro Health Medical Center - Case Western Reserve University, Cleveland, OH, USA
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Ting CY, Shahdadpuri R. Fuchs syndrome: a case of fever, mucositis and conjunctivitis. BMJ Case Rep 2018; 2018:bcr-2017-223321. [PMID: 29378740 PMCID: PMC5812416 DOI: 10.1136/bcr-2017-223321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/03/2022] Open
Affiliation(s)
- Chun Yi Ting
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Raveen Shahdadpuri
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
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Gossart R, Malthiery E, Aguilar F, Torres JH, Fauroux MA. Fuchs Syndrome: Medical Treatment of 1 Case and Literature Review. Case Rep Dermatol 2017; 9:114-120. [PMID: 28559809 PMCID: PMC5437436 DOI: 10.1159/000468978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/22/2022] Open
Abstract
Fuchs syndrome is a particular type of erythema multiforme major; the lesions are only found on the mucosae and specifically affect oral, ocular, and genital mucosae. The cause is not always immediately apparent, which is why this pathology requires a rigorous, detailed clinical examination to eliminate a differential diagnosis. The severity of the symptoms, particularly of oral and ocular symptoms, requires immediate treatment. The treatment of this pathology requires a multiple-drug regime. Through a clinical case study, the objective of this work is to help guide practitioners when diagnosing and treating this pathology as no current consensus exists on these 2 subjects. The authors present the case of a 29-year-old patient who was suffering from a recurring outbreak of Fuchs syndrome, suspected of having been triggered by Mycoplasma pneumoniae. After completing the treatment program based on colchicine and prednisolone, the patient was relieved from pain and has not suffered from any further periodic eruptions of erythema multiforme.
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Affiliation(s)
- Rémy Gossart
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Eve Malthiery
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Fanny Aguilar
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Jacques-Henri Torres
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
| | - Marie-Alix Fauroux
- Department of Odontology, University Hospital of Montpellier, Montpellier, France
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Kapoor S. Fuchs syndrome: A rare and unique variant of Stevens-Johnson Syndrome. Am J Emerg Med 2016; 34:910. [DOI: 10.1016/j.ajem.2016.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Accepted: 01/31/2016] [Indexed: 10/22/2022] Open
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Meyer Sauteur PM, Unger WWJ, Nadal D, Berger C, Vink C, van Rossum AMC. Infection with and Carriage of Mycoplasma pneumoniae in Children. Front Microbiol 2016; 7:329. [PMID: 27047456 PMCID: PMC4803743 DOI: 10.3389/fmicb.2016.00329] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/02/2016] [Indexed: 12/18/2022] Open
Abstract
“Atypical” pneumonia was described as a distinct and mild form of community-acquired pneumonia (CAP) already before Mycoplasma pneumoniae had been discovered and recognized as its cause. M. pneumoniae is detected in CAP patients most frequently among school-aged children from 5 to 15 years of age, with a decline after adolescence and tapering off in adulthood. Detection rates by polymerase chain reaction (PCR) or serology in children with CAP admitted to the hospital amount 4–39%. Although the infection is generally mild and self-limiting, patients of every age can develop severe or extrapulmonary disease. Recent studies indicate that high rates of healthy children carry M. pneumoniae in the upper respiratory tract and that current diagnostic PCR or serology cannot discriminate between M. pneumoniae infection and carriage. Further, symptoms and radiologic features are not specific for M. pneumoniae infection. Thus, patients may be unnecessarily treated with antimicrobials against M. pneumoniae. Macrolides are the first-line antibiotics for this entity in children younger than 8 years of age. Overall macrolides are extensively used worldwide, and this has led to the emergence of macrolide-resistant M. pneumoniae, which may be associated with severe clinical features and more extrapulmonary complications. This review focuses on the characteristics of M. pneumoniae infections in children, and exemplifies that simple clinical decision rules may help identifying children at high risk for CAP due to M. pneumoniae. This may aid physicians in prescribing appropriate first-line antibiotics, since current diagnostic tests for M. pneumoniae infection are not reliably predictive.
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Affiliation(s)
- Patrick M Meyer Sauteur
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical CenterRotterdam, Netherlands; Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical CenterRotterdam, Netherlands; Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of ZurichZurich, Switzerland
| | - Wendy W J Unger
- Laboratory of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
| | - David Nadal
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of Zurich Zurich, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Hospital Epidemiology, and Children's Research Center, University Children's Hospital of Zurich Zurich, Switzerland
| | - Cornelis Vink
- Erasmus University College, Erasmus University Rotterdam, Netherlands
| | - Annemarie M C van Rossum
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Netherlands
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Olson D, Watkins LKF, Demirjian A, Lin X, Robinson CC, Pretty K, Benitez AJ, Winchell JM, Diaz MH, Miller LA, Foo TA, Mason MD, Lauper UL, Kupfer O, Kennedy J, Glodé MP, Kutty PK, Dominguez SR. Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome. Pediatrics 2015; 136. [PMID: 26216320 PMCID: PMC4516944 DOI: 10.1542/peds.2015-0278] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado. METHODS Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection. RESULTS During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 7.5, confidence interval [CI] 1.6–35.1), preceding respiratory symptoms (OR 30.0, CI 3.3–269.4) [corrected] an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1-244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23). CONCLUSIONS We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.
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Affiliation(s)
| | - Louise K. Francois Watkins
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alicia Demirjian
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xia Lin
- Centers for Disease Control and Prevention, Atlanta, Georgia;,Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christine C. Robinson
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Kristin Pretty
- Department of Pathology and Laboratory Medicine, Children's Hospital Colorado, Aurora, Colorado
| | | | | | - Maureen H. Diaz
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa A. Miller
- Colorado Department of Public Health and Environment, Denver, Colorado
| | - Teresa A. Foo
- University of Colorado School of Medicine, Aurora, Colorado
| | | | | | | | | | | | - Preeta K. Kutty
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Terraneo L, Lava SA, Camozzi P, Zgraggen L, Simonetti GD, Bianchetti MG, Milani GP. Unusual Eruptions Associated with Mycoplasma pneumoniae Respiratory Infections: Review of the Literature. Dermatology 2015; 231:152-7. [DOI: 10.1159/000430809] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 04/18/2015] [Indexed: 11/19/2022] Open
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Canavan TN, Mathes EF, Frieden I, Shinkai K. Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review. J Am Acad Dermatol 2015; 72:239-45. [PMID: 25592340 DOI: 10.1016/j.jaad.2014.06.026] [Citation(s) in RCA: 188] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 06/07/2014] [Accepted: 06/11/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae infection is associated with extrapulmonary complications, including mucocutaneous eruptions. These eruptions, which have been termed either "Stevens-Johnson syndrome" or "erythema multiforme" in the literature, may differ from drug-induced Stevens-Johnson syndrome or viral-associated erythema multiforme. OBJECTIVE We sought to review the literature characterizing morphology and disease course of M pneumoniae-associated mucocutaneous disease. METHODS A comprehensive literature search identified 95 articles with 202 cases. RESULTS Patients were often young (mean age: 11.9 years) and male (66%). Cutaneous involvement ranged from absent (34%), to sparse (47%), to moderate (19%). Oral, ocular, and urogenital mucositis was reported in 94%, 82%, and 63% of cases, respectively. Treatments included antibiotics (80%), systemic corticosteroids (35%), supportive care alone (8%), and/or intravenous immunoglobulin (8%). Complications included mucosal damage (10%), cutaneous scarring (5.6%), recurrence (8%), and mortality (3%). LIMITATIONS Mild cases may not have been published; thus this review may have a bias toward more severe disease. CONCLUSION M pneumoniae-associated mucocutaneous disease has prominent mucositis and sparse cutaneous involvement, although cutaneous involvement varies. Because of the distinct morphology, mild disease course, and potentially important clinical implications regarding treatment, we propose a revision of the nomenclature system and suggest the term "Mycoplasma-induced rash and mucositis" for these cases.
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Affiliation(s)
- Theresa N Canavan
- Department of Dermatology, University of Alabama, Birmingham, Alabama
| | - Erin F Mathes
- Department of Dermatology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California
| | - Ilona Frieden
- Department of Dermatology, University of California, San Francisco, California; Department of Pediatrics, University of California, San Francisco, California
| | - Kanade Shinkai
- Department of Dermatology, University of California, San Francisco, California.
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Vujic I, Shroff A, Grzelka M, Posch C, Monshi B, Sanlorenzo M, Ortiz-Urda S, Rappersberger K. Mycoplasma pneumoniae-associated mucositis--case report and systematic review of literature. J Eur Acad Dermatol Venereol 2014; 29:595-8. [PMID: 24665876 DOI: 10.1111/jdv.12392] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae, a bacterium known to be a common cause of pneumonia, has been documented to cause complications such as debilitating mucositis previously described as an atypical Stevens-Johnson syndrome without skin lesions. However, in the spectrum of epidermal dermatopathies, the condition is increasingly recognized as a separate entity, now termed M. pneumoniae-associated mucositis (MPAM). OBJECTIVES We present a case of MPAM and systemically review the literature to discuss diagnostic and therapeutic options. METHODS A systematic literature search was performed to find studies reporting MPAM in adults. We extracted and analysed patient demographics, disease symptomatology, diagnostic testing and treatment. RESULTS Eleven articles, describing 12 patients and our own patient met the predefined criteria and were analysed. Respiratory, ocular and oral symptoms were present in all patients. Therapies predominantly included antibiotics (10 of 13) and immunosuppressive treatment (9 of 13) leading to complete resolution of symptoms in all patients. CONCLUSION Our findings highlight that MPAM should be recognized as a distinct disease entity within the spectrum of epidermal dermatopathies. We discuss and show in our patient why M. pneumoniae IgA serum levels could prove to be more reliable diagnostic tools in the MPAM diagnosis than the widely used IgG and IgM titre levels.
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Affiliation(s)
- I Vujic
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA; Department of Dermatology, The Rudolfstiftung Hospital, Vienna, Austria
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Hsiao YH, Hui RCY, Wu T, Chang WC, Hsih MS, Yang CH, Ho HC, Chang YG, Chen MJ, Lin JY, Chen DP, Chang PY, Wu TL, Hung SI, Chung WH. Genotype–phenotype association between HLA and carbamazepine-induced hypersensitivity reactions: Strength and clinical correlations. J Dermatol Sci 2014; 73:101-9. [DOI: 10.1016/j.jdermsci.2013.10.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 10/11/2013] [Accepted: 10/15/2013] [Indexed: 11/17/2022]
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Meyer Sauteur PM, Goetschel P, Lautenschlager S. Mycoplasma pneumoniae and mucositis--part of the Stevens-Johnson syndrome spectrum. J Dtsch Dermatol Ges 2012; 10:740-6. [PMID: 22672205 DOI: 10.1111/j.1610-0387.2012.07951.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae may induce mucosal inflammation, referred to as M. pneumoniae-associated mucositis (MPAM). There is no generally accepted definition of MPAM, since there may be mucosal lesions only, or mucosal and minimal skin lesions. PATIENTS AND METHODS We conducted a literature review of MPAM, paying particular attention to pathogenesis, clinical manifestations, treatment decisions, and prognosis. RESULTS We identified 32 cases of MPAM (median age 13.5 years), whereof 23 patients were otherwise healthy children and young adolescents (72%). M. pneumoniae infection was associated with fever and respiratory symptoms in all calls; it was confirmed by serology (n = 30) and/or PCR (n = 9). Oral lesions were present in all cases, followed by ocular (97%) and uro-genital lesions (78%). Despite the syndrome's name postulating the absence of cutaneous involvement, minimal skin lesions occurred in 31%. Treatment regimens included systemic antibiotics (100%) and systemic anti-inflammatory treatment with corticosteroids (31%) or immunoglobulins (9%). Macrolides were given in 81%, with failure, relapse, and/or worsening in one-third of patients. No patient suffered long-term sequelae. CONCLUSION MPAM is a distinct extra-pulmonary manifestation falling into the continuum of Stevens-Johnson syndrome. This entity may be due to inflammatory mechanisms suggesting that systemic anti-inflammatory treatment is even more important than antimicrobials.
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Schalock PC, Thyssen JP, Dinulos JGH. Mycoplasma pneumoniae-associated mucositis: by any other name is not so sweet. Pediatr Dermatol 2012; 29:392. [PMID: 22594340 DOI: 10.1111/j.1525-1470.2011.01694.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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