1.Case Report

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Two boys with five and six years-old respectivelypresented with a 4-day history of non-productive cough, headache and fever, complaining of mouth soreness and painful lip lesions. Physical examination revealed conjunctivitis in both, buccal mucosa and lips showed painful ulcerative bleeding lesions covered with serofibrinous exudates. The younger patient presented a rash on the palms, soles of the feet, back, and scattered throughout the extremities (Figure 1). Genital mucosa was unremarkable and lung auscultation revealed minor crackles with a mild bilateral interstitial pattern on chest radiograph. The older patient developed urethral discharge and a small, non-painful ulcer on his glans penis (Figure 2). His lung auscultation revealed bilateral wheezing and fine end-inspiratory crepitations.

In both patients, laboratory examinations were significant for leukocytosis and a Mycoplasma pneumonia IgM positive by enzyme immunoassay. The remainder of the laboratory evaluation was normal including hematocrit, platelets, electrolytes, and Venereal Disease Research Laboratory (VDRL). Stevens Johnson syndrome secondary to Mycoplasma pneumoniae infection was diagnosed. The patients started intravenous azithromycin for a 5-day course. Adequate supportive care including wound care, fluid and electrolyte management, nutritional support and monitoring for superinfections was provided. Symptoms resolved completely within 2 weeks, and the patients are in good health after a six months follow-up.

The Stevens Johnson syndrome is a variant of erythema multiforme, a rare acute mucocutaneous condition caused by a hypersensitivity reaction.1 Skin, oral and genital mucosa, lips, and conjunctivae are particularly involved [1,2]. Drugs and infections, most commonly Mycoplasmapneumoniae, are well-known precipitating factors [1-3]. Treatment remains supportive and symptomatic.

Figure1     Figure2

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