Mycoplasma induced Steven-Johnson Syndrome/Toxic Epidermal Necrolysis: Case-control analysis of a cohort managed in a specialized center.

Abstract

BACKGROUND\nMycoplasma pneumoniae (MP) infection is associated with extrapulmonary complications such as Stevens-Johnson syndrome (SJS)/Toxic epidermal necrolysis(TEN).\n\n\nOBJECTIVE\nWe evaluated the differences in epidemiology, clinical characteristics, and disease outcomes between drug-induced and mycoplasma related SJS/TEN.\n\n\nMETHODS\nAll patients with SJS/TEN admitted to our center between 2003 and 2016 inclusive were treated under a standardized protocol. Comparative analysis was made between patients who tested positive for MP versus a control group with negative MP serology in the presence of high notoriety drugs defined by ALDEN>5.\n\n\nRESULTS\nSix patients with positive MP serologies were compared to a control group of 71 cases of drug-induced SJS/TEN with an ALDEN score of >5 out of 180 cases of SJS/TEN patients treated in our institution. There was no significant difference in baseline characteristics, disease classification, body surface area involved, and extent of mucosal involvement. We found significant differences in mortality rates on discharge (0% vs 22.5%, p-value<0.001) and 1year follow up (0% vs 32.4%, p-value 0.002) in the mycoplasma and control groups respectively.\n\n\nLIMITATIONS\nRetrospective design, small sample size CONCLUSION: Although recent studies have shown that MP induced SJS/TEN is morphologically different and deserves a separate classification system; this would need to be borne out in larger prospective studies.