Mucositis bij longontsteking door Mycoplasma

Background Mycoplasma pneumonia (M. pneumonia) is a frequent cause of respiratory tract infections, especially in adolescents. Less known is the relation between M. pneumonia infections and mucositis without obvious skin involvement, described as M. pneumonia Associated Mucositis (MPAM). We describe a case with a MPAM Case description A Dutch man of 19 years old was referred to the emergency department of internal medicine. He had complaints of coughing and fever since 7 days. The general practioner (GP) prescribed amoxicillin. Next day an exanthema on both arms developed and he began to complain of a soar throat. The next day his lips became swollen and multiple blisters appeared in his mouth and he experienced shortness of breath. He was referred to the hospital by his GP. By presentation he was sick looking, had fever (39 degrees), a bilateral conjunctivitis, stomatitis and urethritis. On both arms some macula were visible. He was treated for an allergic reaction with intravenous clemastin and dexamethasone, without improvement. Extensive microbiological investigation was performed, including cultures of blood and vesicles, serology and/or PCR for Epstein-Barr Virus (EBV), Cytomegaly Virus (CMV), parvo-B19 virus, herpes simplex virus (HSV), human immunodeficiency virus (HIV) and sexually transmitted diseases. The clinical situation deteriorated and intravenous flucloxacillin was started. He was fed by a nasogastric tube, and needed morphine for pain control. Besides a positive IgM for HSV and group B streptococci in a culture of a blister the microbiological investigations remained negative. After 4 days serology for M. pneumonia was ordered. This turned out to be positive. In retrospect a PCR for M. pneumonia on a throat swab obtained at admission was ordered. This was also positive. Since he still had fever, treatment with doxycycline was started. The next day he was afebrile and started to recover. Mucosal lesions healed within two weeks. Conclusion This case highlights the relation between M. pneumonia infection and mucositis in de absence of obvious skin manifestations. Antibiotic treatment may shorten the duration of illness. Mucosal lesions recovered within two weeks.