Reyhan Amode1, Saskia Ingen-Housz-Oro2, Nicolas Ortonne3, Touda Bounfour1, Sabine Pereyre4, Frédéric Schlemmer5, Emilie Bequignon6, Gérard Royer7, Pierre Wolkenstein8, Olivier Chosidow8. 1. Dermatology Department, Assistance Publique Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France. 2. Dermatology Department, Assistance Publique Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France; Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Créteil (UPEC) Val de Marne, Créteil, France; Referral Center for Toxic Bullous Diseases, AP-HP, Henri Mondor Hospital, Créteil, France. Electronic address: saskia.oro@aphp.fr. 3. Pathology Department, AP-HP, Henri Mondor Hospital, Créteil, France; UPEC, Créteil, France. 4. Université Bordeaux, National Institute for Agricultural Research, Mycoplasmal and Chlamydial Infections in Humans, Bordeaux, France; Bacteriology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France. 5. Pneumology Department, AP-HP, Henri Mondor Hospital, Créteil and Département Hospitalo-Universitaire A-TVB (Ageing-Thorax-Vessel-Blood), UPEC, Créteil, France. 6. Ear-Nose-Throat - Head and Neck Surgery Department, AP-HP, Henri Mondor Hospital, Créteil, France. 7. Ophthalmology Department, AP-HP, Henri Mondor Hospital, Créteil, France. 8. Dermatology Department, Assistance Publique Hôpitaux de Paris (AP-HP), Henri Mondor Hospital, Créteil, France; Epidémiologie en Dermatologie et Evaluation des Thérapeutiques, Université Paris-Est Créteil (UPEC) Val de Marne, Créteil, France; Referral Center for Toxic Bullous Diseases, AP-HP, Henri Mondor Hospital, Créteil, France; UPEC, Créteil, France.
Abstract
BACKGROUND: Mycoplasma pneumoniae infection has been documented in erythema multiforme (EM) and Stevens-Johnson syndrome-toxic epidermal necrosis (SJS-TEN). Clinical aspects of M pneumoniae-related EM have been poorly described in the literature. OBJECTIVE: To highlight differences between M pneumoniae EM and non-M pneumoniae EM. METHODS: This single-center, retrospective cohort study included all patients admitted to our dermatology department for EM during 2000-2015. We compared epidemiologic, clinical, and histologic data and follow-up for M pneumoniae EM and non-M pneumoniae EM cases. RESULTS: Thirty-three patients with M pneumoniae EM were compared with 100 patients with non-M pneumoniae EM. Disease onset in winter was more frequent with M pneumoniae EM (P = .003). Acrally distributed lesions (32% vs 88%, P < .0001) and typical targets (45% vs 74%, P = .01) were less common in M pneumoniae EM than non-M pneumoniae EM. Multiple (≥2) mucousal membrane involvement was more frequent in M pneumoniae EM than non-M pneumoniae EM (97% vs 60%; P < .0001), as were mucosal and respiratory tract sequelae (P < .05). The mean hospital stay was longer with M pneumoniae EM patients: 9.5 days versus 5.1 days (P = .0002). A TEN-like pattern was observed in all 14 (100%) M pneumoniae EM skin biopsies versus 10 of 27 (48%) non-M pneumoniae EM biopsies (P < .001). LIMITATIONS: The retrospective design. CONCLUSION: M pneumoniae EM has a distinctive presentation compared with non-M pneumoniae EM, with more diffuse and atypical targets, more mucositis and respiratory tract sequelae. Histologic data show a TEN-like pattern in all M pneumoniae EM skin samples.
BACKGROUND:Mycoplasma pneumoniae infection has been documented in erythema multiforme (EM) and Stevens-Johnson syndrome-toxic epidermal necrosis (SJS-TEN). Clinical aspects of M pneumoniae-related EM have been poorly described in the literature. OBJECTIVE: To highlight differences between M pneumoniae EM and non-M pneumoniae EM. METHODS: This single-center, retrospective cohort study included all patients admitted to our dermatology department for EM during 2000-2015. We compared epidemiologic, clinical, and histologic data and follow-up for M pneumoniae EM and non-M pneumoniae EM cases. RESULTS: Thirty-three patients with M pneumoniae EM were compared with 100 patients with non-M pneumoniae EM. Disease onset in winter was more frequent with M pneumoniae EM (P = .003). Acrally distributed lesions (32% vs 88%, P < .0001) and typical targets (45% vs 74%, P = .01) were less common in M pneumoniae EM than non-M pneumoniae EM. Multiple (≥2) mucousal membrane involvement was more frequent in M pneumoniae EM than non-M pneumoniae EM (97% vs 60%; P < .0001), as were mucosal and respiratory tract sequelae (P < .05). The mean hospital stay was longer with M pneumoniae EM patients: 9.5 days versus 5.1 days (P = .0002). A TEN-like pattern was observed in all 14 (100%) M pneumoniae EM skin biopsies versus 10 of 27 (48%) non-M pneumoniae EM biopsies (P < .001). LIMITATIONS: The retrospective design. CONCLUSION: M pneumoniae EM has a distinctive presentation compared with non-M pneumoniae EM, with more diffuse and atypical targets, more mucositis and respiratory tract sequelae. Histologic data show a TEN-like pattern in all M pneumoniae EM skin samples.