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. 2015 Aug;136(2):e386-94.
doi: 10.1542/peds.2015-0278.

Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome

Daniel Olson  1 , Louise K Francois Watkins  2 , Alicia Demirjian  2 , Xia Lin  2 , Christine C Robinson  3 , Kristin Pretty  3 , Alvaro J Benitez  4 , Jonas M Winchell  4 , Maureen H Diaz  4 , Lisa A Miller  5 , Teresa A Foo  6 , Melanie D Mason  7 , Ursula L Lauper  8 , Oren Kupfer  9 , Jeffrey Kennedy  10 , Mary P Glodé  9 , Preeta K Kutty  4 , Samuel R Dominguez  9
Affiliations

Outbreak of Mycoplasma pneumoniae-Associated Stevens-Johnson Syndrome

Daniel Olson et al. Pediatrics. 2015 Aug.

Erratum in

Abstract

Background: Stevens-Johnson syndrome (SJS) is an uncommon, sporadic disease and outbreaks are rare. In November 2013, an outbreak of SJS was identified at Children's Hospital Colorado.

Methods: Outbreak cases were children aged 5-21 with a discharge diagnosis of SJS admitted from September 1 to November 30, 2013. Medical charts were reviewed using standardized data collection forms. Respiratory specimens were tested for viruses and Mycoplasma pneumoniae (Mp) by polymerase chain reaction (PCR). We conducted a separate 4-year retrospective case-control study comparing hospitalized SJS cases with and without evidence of Mp infection.

Results: During the outbreak, 8 children met SJS criteria. Median age was 11.5 years (range 8-16 years); 5 (63%) were boys and 5 (63%) were Mp-PCR-positive. Of the 5 PCR-positive children, none had preceding medication exposure, and all had radiographic pneumonia. All outbreak Mp isolates were macrolide susceptible. The retrospective case-control analysis showed that Mp-associated SJS episodes (n = 17) were more likely to have pneumonia (odds ratio [OR] 7.5, confidence interval [CI] 1.6–35.1), preceding respiratory symptoms (OR 30.0, CI 3.3–269.4) [corrected] an erythrocyte sedimentation rate ≥35 mg/dL (OR 22.8, CI 2.1-244.9), and ≤3 affected skin sites (OR 4.5, CI 1.2-17.4) than non-Mp-associated SJS episodes (n = 23).

Conclusions: We report the largest outbreak of SJS in children, which was also predominately associated with Mp infection. Mp-associated SJS was associated with a distinct clinical presentation that included less extensive skin disease, an elevated erythrocyte sedimentation rate, and evidence of a preceding respiratory infection.

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Figures

FIGURE 1
FIGURE 1
Cases of SJS secondary to Mp at CHCO, October 2008–November 2013. CUSUM analysis indicated an SJS outbreak occurred during September 2011 and September to November 2013. formula image Confirmed Mp-associated SJS, formula image probable Mp-associated SJS, formula image possible Mp-associated SJS, and formula image non–Mp-associated SJS.
FIGURE 2
FIGURE 2
Images of lesions in patients with Mp-associated Stevens-Johnson syndrome. Skin manifestations (A) were mild, with severe oropharyngeal (B) and conjunctival (C and D) disease.
See this image and copyright information in PMC

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