I M AG E S D x
Stevens-Johnson and Mycoplasma Pneumoniae: A Scary Duo
Moises Auron, MD, FAAP, FACP1,2
Brian Harte, MD, FACP, FHM1
1Department of Hospital Medicine, Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
2 Center for Pediatric Hospital Medicine, Children’s Hospital, Cleveland Clinic, Cleveland, Ohio.
Disclosure: Nothing to report.
A 15-year-old male was hospitalized with painful blisters on
the lips and ulcers in the oral mucosa that were preceded
by upper respiratory infection symptoms for 1 week. He had
not been treated with antimicrobials. He subsequently
developed conjunctival injection and painful blisters at the
urethral meatus and symmetric scattered target lesions in
the extremities. Examination demonstrated low-grade fever,
mild conjunctival injection (Figure 2), and oral vesicular
lesions affecting the lips (Figure 1) and both the hard and
soft palate; he had vesicular lesions affecting the glans
penis, a ruptured vesicle at the urethral meatus and target
lesions in the arms (Figure 3) and legs (Figure 4). His car-
diopulmonary exam was normal. He was started on acyclo-
vir and azithromycin, and symptomatic treatment with oral
lidocaine and morphine. Serologies for Epstein-Barr virus
(EBV), cytomegalovirus (CMV) and Coxsackievirus and cul-
tures for herpes simplex virus (HSV) were negative. Myco-
plasma pneumoniae immunoglobulin G (IgG) and IgM titers
were significantly elevated (>4-fold) and the diagnosis made
of Stevens-Johnson syndrome (SJS) secondary to Myco-
plasma pneumoniae infection. He was able to tolerate oral
intake after a 1-week hospital course.
M. pneumoniae infection can cause mucocutaneous
involvement varying from mild mucositis to SJS with signifi-
cant morbidity and mortality,1,2 mostly in the pediatric pop-
ulation. The differential diagnosis includes HSV, Kawasaki,
and Streptococcal toxic shock syndrome, as well as other
viral infections (eg, Coxsackievirus).3 Pharmacologic causes—
especially antibiotics, non steroidal anti-inflammatory drug
(NSAIDS) and anticonvulsants—should also be considered in
the etiology of SJS4 especially in the adult population.
Address for correspondence and reprint requests:
Moises Auron, MD, FAAP, 9500 Euclid Ave. S70, Cleveland, Ohio
44130; Telephone: 216-445-8383; Fax: 216-444-8530; E-mail:
auronm@ccf.org Received 26 August 2009; revision received 9
November 2009; accepted 31 December 2009.
References
1. Schalock PC. Erythema multiforme due to Mycoplasma pneumoniae infec-
tion in two children. Pediatr Dermatol. 2006;23(6):546–555.
2. Sendi P. Mycoplasma pneumoniae infection complicated by severe muco-
cutaneous lesions. Lancet Infect Dis. 2008;8:268.
3. Ravin KA, Rappaport LD, Zuckerbraun NS, Wadowsky RM, Wald ER,
Michaels MM. Mycoplasma pneumoniae and atypical Stevens-Johnson
syndrome: a case series. Pediatrics. 2007;119:e1002–e1005.
4. Mulvey JM, Padowitz A, Lindley-Jones M, Nickels R. Mycoplasma pneumo-
niae associated with Stevens Johnson syndrome. Anaesth Intensive Care.
2007;35:414–417.
2010 Society of Hospital Medicine DOI 10.1002/jhm.664
Published online in Wiley InterScience (www.interscience.wiley.com).
Journal of Hospital Medicine Vol 000 No 000 Month Month 2010 1
FIGURE 3. Target lesions.
FIGURE 4. Target lesions.
FIGURE 1. Oral vesicular lesions and mucositis.
FIGURE 2. Mild conjunctival injection.
2010 Society of Hospital Medicine DOI 10.1002/jhm.664
Published online in Wiley InterScience (www.interscience.wiley.com).
2 Journal of Hospital Medicine Vol 000 No 000 Month Month 2010
