Overlapping clinical presentation of Mycoplasma-induced rash and mucositis and drug-induced Stevens Johnson Syndrome: A case report

Introduction: Mycoplasma pneumoniae is a worldwide occurring common bacterial agent for communityacquired pneumonia especially in children and young people with high contagiousness. Extrapulmonary complications such as cardiopulmonary, gastrointestinal, neurological and mucocutaneous manifestations including Mycoplasma pneumoniae-induced rash and mucositis (MIRM) may occur especially in adults. MIRM is an important differential diagnosis of Stevens Johnson Syndrome (SJS). Both clinically present similar as mucocutaneous erosive eruptions but have different etiologies.Case presentation: We present an atypical case of a 36-year-old female with overlapping clinical features of MIRM and SJS. The patient presented to our allergy-outpatient clinic after recovering from mucocutaneous erosive eruptions and receiving an allergy-passport upon discharge for all drugs administered during the course of treatment including a subsequent ban of all beta-lactam antibiotics and NSAIDs for the future resulting in a desperate patient and treating physicians. A positive result of Mycoplasma pneumoniae in the sputum culture upon discharge was unnoticed. An allergological work-up with skin testing and drug provocation testing with the culprit drugs and safe alternatives was performed which resulted negative. Therefore, a new allergy passport was issued with drug alternatives that the patient may use in the future. A diagnosis of MIRM was subsequently made.Discussion: The present case report depicts the diagnostic algorithm in an atypical case with overlapping clinical features of a MIRM and SJS.Conclusion: Patients with atypical mucocutaneous eruptions of possible allergological etiology should receive a careful allergological work-up in an experienced tertiary referral center to reduce the number of inadequate allergy passport distribution.