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A 38-year-old man presented to the emergency department with a 5-day history of productive cough, shortness of breath, fever, and rash. Physical examination revealed crackles in the right mid-lung field, conjunctival injection (Supplementary Figure 1, available online at http://www.mayoclinicproceedings.org), oral ulcerations, sloughing of the lips (Figure 1), and scattered targetoid lesions over his trunk (Supplementary Figure 2, available online at http://www.mayoclinicproceedings.org) and extremities. Chest roentgenogram showed a right middle lobe consolidation. Herpes simplex virus serology and polymerase chain reaction tests from oral and skin lesions were negative. Sputum Mycoplasma pneumoniae polymerase chain reaction was positive. Skin biopsy (Figure 2) was obtained and showed subepidermal separation with vacuolar interface dermatitis and numerous apoptotic keratinocytes on hematoxylin and eosin stain; direct immunofluorescence was negative. Clinical and histopathologic findings were consistent with Mycoplasma pneumoniae-induced rash and mucositis. The patient was treated with a 7-day course of azithromycin and prednisone. Complete resolution of the mucocutaneous lesions and respiratory illness was observed on follow-up examination.
M. pneumoniae infection with associated mucocutaneous involvement is uncommon, but it is more often seen in children and males. Antibiotic therapy for M. pneumoniae pneumonia should be initiated, while treatment of the mucocutaneous lesions is mainly supportive.
Targetoid skin lesions in conjunction with mucosal ulcerations and ocular involvement in the context of community-acquired pneumonia should raise suspicion for Mycoplasma pneumoniae-induced rash and mucositis.
Supplemental Online Material
Mycoplasma pneumoniae-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: a systematic review.