İlaç Alerjisi Ayırıcı Tanısında Mycoplasma Pneumoniae’nin Neden Olduğu Döküntü ve Mukozit (Mırm)

Yıl 2024, ERKEN GÖRÜNÜMLÜ MAKALELER, 1 - 4

Sinem Polat , Hacer İlbilge Ertoy Karagöl , Gizem Koken , A Tapisiz , Arzu Bakırtaş

https://doi.org/10.12956/tchd.1499268

Öz

Mycoplasma pneumoniae (MP) enfeksiyonu ile ilişkili mukokütanöz döküntüler, MP’nin neden olduğu döküntü ve mukozit olarak tanımlanan yeni bir terimle açıklanmaktadır. Amoksisilin-klavulanik asit’in ilk dozundan sonra, 17 yaşındaki bir erkek çocuğunda döküntü, iki taraflı pürülan konjonktivit, ağız ve genital ülserler gelişmiş ve hastaya ilaç alerjisi ön tanısı konulmuştur. Hasta, Stevens-Johnson sendromu ön tanısıyla hastaneye yatırılıp, sistemik steroid tedavisine başlanmıştır. Takip sürecinde, hastada laboratuvar testleri ile doğrulanan MP nedenli pnömoni gelişmiş ve hastaya MP’nin neden olduğu döküntü ve mukozit tanısı konulmuştur. Hasta, azitromisin ve intravenöz immünoglobulin tedavisi ile iki hafta içinde tamamen iyileşmiştir. Bu olguda, ilaç alerjisi ayırıcı tanısında dikkate alınması gereken MP’nin neden olduğu döküntü ve mukozitli bir olguyu tartışmayı ve bu duruma dair farkındalığı artırmayı amaçladık.

Anahtar Kelimeler

Ergen, ilaç alerjisi, Mycoplasma pneumoniae’nin neden olduğu döküntü ve mukozit

Mycoplasma Pneumoniae Induced Rash and Mucositis (Mirm): in the Differential Diagnosis of Drug Allergy

Öz

Mucocutaneous eruptions associated with Mycoplasma pneumoniae (MP) infection has been newly termed ‘MP-induced rash and mucositis (MIRM)’. A 17-year-old male developed a rash, bilateral purulent conjunctivitis, and oral and genital ulcers after the first dose of amoxicillin-clavulanic acid, initially considered as a drug allergy. Following hospitalization under a preliminary diagnosis of Stevens-Johnson syndrome and initiation of systemic steroids, he developed pneumonia. Laboratory tests confirmed MP infection, leading to a refined diagnosis of MIRM. The patient fully recovered within two weeks following treatment with azithromycin and intravenous immunoglobulin. This case underscores the importance of considering MIRM in the differential diagnosis of drug allergies and aims to enhance awareness of this condition.

Anahtar Kelimeler

adolescent, drug allergy, mycoplasma pneumoniae induced rash and mucositis

Kaynakça

• Marchello C, Dale AP, Thai TN, Han DS, Ebell MH. Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis. Ann Fam Med 2016;14:552-66.
• Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev 2004;17:697-728.
• 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.
• Caubet JC, Eigenmann PA. Diagnostic issues in pediatric drug allergy. Curr Opin Allergy Clin Immunol 2012;12:341-7.
• Mattheij M, de Vries E. A suspicion of antibiotic allergy in children is often incorrect. J Allergy Clin Immunol 2012;129:583.
• Caubet JC, Kaiser L, Lemaître B, Fellay B, Gervaix A, Eigenmann PA. The role of penicillin in benign skin rashes in childhood: a prospective study based on drug rechallenge. J Allergy Clin Immunol 2011;127:218-22.
• Ponvert C, Perrin Y, Bados-Albiero A, Le Bourgeois M, Karila C, Delacourt C, et al. Allergy to betalactam antibiotics in children: results of a 20-year study based on clinical history, skin and challenge tests. Pediatr Allergy Immunol 2011;22:411-8.
• Huang PW, Chiou MH, Chien MY, Chen WW, Chu CY. Analysis of severe cutaneous adverse reactions (SCARs) in Taiwan drug-injury relief system: 18-year results. J Formos Med Assoc 2022;121:1397-405.
• Lofgren D, Lenkeit C. Mycoplasma Pneumoniae-Induced Rash and Mucositis: A Systematic Review of the Literature. Spartan Med Res J 2021;6:25284.
• Creamer D, Walsh SA, Dziewulski P, Exton LS, Lee HY, Dart JKG, et al. UK guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 2016. J Plast Reconstr Aesthet Surg 2016;69:119-53.
• Meyer Sauteur PM, Theiler M, Buettcher M, Seiler M, Weibel L, Berger C. Frequency and Clinical Presentation of Mucocutaneous Disease Due to Mycoplasma pneumoniae Infection in Children With Community-Acquired Pneumonia. JAMA Dermatol 2020;156:144-50.
• Reichert-Penetrat S, Barbaud A, Antunes A, Borsa-Dorion A, Vidailhet M, Schmutz JL. An unusual form of Stevens-Johnson syndrome with subcorneal pustules associated with Mycoplasma pneumoniae infection. Pediatr Dermatol 2000;17:202-4.
• Kunimi Y, Hirata Y, Aihara M, Yamane Y, Ikezawa Z. Statistical analysis of Stevens-Johnson syndrome caused by Mycoplasma pneumonia infection in Japan. Allergol Int 2011;60:525-32.
• Azimi PH, Chase PA, Petru AM. Mycoplasmas: their role in pediatric disease. Curr Probl Pediatr 1984;14:1-46.
• Martire B, Foti C, Cassano N, Buquicchio R, Del Vecchio GC, De Mattia D. Persistent B-cell lymphopenia, multiorgan disease, and erythema multiforme caused by Mycoplasma pneumoniae infection. Pediatr Dermatol 2005;22:558-60.