Diagnosis of Mycoplasma-Induced Rash with Mucositis (MIRM) Mimicking Steven Johnson Syndrome (SJS) in Children as a New Entity: A Case Report

Mycoplasma pneumoniae (MP) is a pathogen commonly associated with respiratory illnesses. It accounts for about 40% of community-acquired pneumonia (CAP) cases, and approximately 25% of cases exhibit extrapulmonary manifestations, affecting children's mucocutaneous, skeletal, and hematological systems. The mucocutaneous syndrome associated with MP presents distinctive rashes commonly affecting the preschool age. A recent study introduced Mycoplasma-Induced Rash and Mucositis (MIRM) to describe MP’s involvement with mucosal and cutaneous symptoms. MIRM poses a significant diagnostic challenge for clinicians as it can mimic other mucocutaneous syndromes. This study documented a case of a three-year-old patient with a three-day history of fever associated with respiratory symptoms, rashes, bilateral conjunctivitis, and severe mucositis. Although the patient’s breathing improved after the second day of admission, widespread rashes, bilateral conjunctivitis, and worsening mucositis were observed. Initially suspected to be atypical Steven Johnson Syndrome (SJS), the diagnosis was re-evaluated after a mycoplasma serology test result for IgM was positive with a raised titre of 1:1230, and the patient was diagnosed with MIRM. The patient received and completed a five-day course of intravenous azithromycin with supportive management, including oral care, hydration, and pain relief. This case study describes a rare occurrence of MIRM in pediatric patients. It emphasizes the challenges of diagnosing MRIM in pediatric patients and enlightens the medical community on the importance of distinguishing it from other mucocutaneous syndromes.