Abstract / Summary
Mycoplasma pneumoniae–induced rash and mucositis (MIRM) is a distinct mucocutaneous entity predominantly affecting children and adolescents, characterized by severe mucositis with limited or absent cutaneous involvement following infection with Mycoplasma pneumoniae. The objective of the study was to describe the clinical spectrum, diagnostic challenges, management, and outcomes of adolescent patients diagnosed with MIRM at a tertiary care center. A retrospective review of 10 children diagnosed with MIRM between February 2024 and January 2026 was conducted. Clinical features, laboratory findings, radiological evidence and outcomes were analyzed. The study included 7 males and 3 females aged 10–18 years. Eight patients had preceding respiratory symptoms. The average duration between onset of prodromal respiratory symptoms and development of mucocutaneous lesions was 5.2 days. All patients had mucosal involvement, most commonly oral (90%), genital (80%) and conjunctival (70%). Six patients exhibited limited cutaneous lesions, while two had no skin involvement. Chest imaging revealed lobar or segmental consolidation and bilateral ground-glass opacities in four patients each. The majority of cases were initially misdiagnosed as SJS due to antecedent drug exposure. Following confirmation of M. pneumoniae infection, patients were treated with macrolide antibiotics along with short-term systemic corticosteroids and/or cyclosporine and supportive care. Six patients required systemic corticosteroids, while four patients required additional cyclosporine. All patients showed favourable clinical outcomes, with recurrence seen only in 1 patient during follow-up. Limitations of the study were retrospective design, small sample size and lack of molecular confirmation. MIRM is an underrecognized but distinct mucocutaneous syndrome characterized by prominent mucosal involvement and limited skin disease following M. pneumoniae infection. Awareness of its clinical features and differentiation from Stevens–Johnson syndrome (SJS), erythema multiforme (EM) and reactive infectious mucocutaneous eruptions (RIME) are crucial to prevent misdiagnosis and unnecessary drug avoidance. Early diagnosis and appropriate management result in excellent clinical outcomes.