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Mycoplasma Pneumoniae Infections and Stevens-Johnson Syndrome

Report of Eight Cases and Review of the Literature

From the Department of Paediatrics, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario Canada M5G 1X8

Neil H. Shear

From the Division of Clinical Pharmacology (Department of Paediatrics), The Hospital for sick Children and the Division of Dermatology (Department of Medicine), Sunnybrook Health Science Centre, and the University of Toronto, Toronto, Canada

On the basis of a literature review and eight cases of our own, we analyzed 37 cases of Mycoplasma pneumoniae (MP) infection and Stevens-Johnson syndrome (SJS). Our clinical and laboratory findings do not differ from those reported in the literature for MP infection with no exanthem or for SJS of various etiologies. Eighty percent of the children presented with symptoms of upper respiratory tract infection (URTI) (cough, fever, sore throat, malaise, headache), with a mean of 10 days (range 1 to 30) before skin rash broke out. Skin manifestations occurred in 94.2% of the patients after 3 to 21 days (mean 10.3 days) of fever. The exanthem, composed predominantly of maculopapular and vesicular, was distributed chiefly on the trunk and extremities and lasted less than 14 days in 87.8% of the patients. Stomatitis was observed in 91.6% of the patients and conjunctivitis in 50%. No consistent pattern seems to emerge by which one could predict the existence of MP infection causing SJS. The complications of SJS associated with MP seem less frequent (2.7%) and much less severe than in cases where SJS arises from other reported causes. Because coincidence cannot be excluded from the assessments of the degree and rate of improvement for the few patients treated with corticosteroid, from the low frequency of complications, and from the mortality rate of zero in this series of patients, the use of corticosteroids for SJS associated with MP infection is questionable.

Clinical Pediatrics, Vol. 30, No. 1, 42-49 (1991)
DOI: 10.1177/000992289103000107


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