Clinical Case 2
Farrah Nasrollahi, M.D.
Chief Complaint: cough and rash
9 year old male with no significant medical hx presenting to ED due to cough of 1 days time + oral rash of 1 days time. Mother has not documented any fevers at home but reports cold like symptoms. Denies sick contacts besides siblings with diarrhea. Patient has taken OTC cough medication (dayquil, robutussion PRN) which has not helped with cough and cold symptoms. Denies nausea, vomiting, diarrhea, constipation, hematuria, back pain. Reports minor dysuria. Denies headache , lightheadedness, dizziness, rashes or changes in color to the extremities, hands, soles, torso or face. Mother has noted redness of the eye and rhinorrhea. Patient is UTD on vaccinations and has not had any recent travel or recent infections with abx treatment. Patient has no known allergies. Family hx is noncontributory. No previous surgeries.
9 yo M with nosig pmh here for wheezing, fever, cough, oral lesions. Oral lesions started today. Decreased po today. +pain with urination. no rash on hands or feet. No history of wheezing in the past. No new meds except dayquil and robitussin. No recent travel or new exposures. No notable PMH, PSH, no known family hx of asthma. Immunizations UTD.
Temp(F/C) 102.4/39.1 → repeat 99.3/37.4
Weight 28.9 kg
Resident Physical Exam
Gen: WDWN, in NAD
Click for diagnosis and more
Mycoplasma Pneumonia with MIRM
Prominent mucositis, usually with sparse or even absent cutaneous involvement.
Classic MIRM is characterized by severe mucositis and variable, but generally sparse, cutaneous lesions. Most patients experience a prodrome of cough, malaise, and fever for approximately one week prior to the onset of their mucocutaneous eruption [1)
Urogenital lesions occur in approximately 60 percent of patients and can affect the vulva, vagina, any part of the penis (including the urethral meatus), and scrotum (1)
Ophthalmology was consulted for eye pain with decreased vision/photophobia
** Of note, herpetic keratitis, typically a result of reactivation of latent disease, may re-occur in 25-50% of patients within 2 years and will require close follow up.
Upon presentation to ED, pt with oral lesion thought to be cold sore in the setting of family hx of fever blisters and cold sores → significant mucositis
Infectious Disease Consult
Initially → RVP positive for Mycoplasma pneumoniae, Bcx negative, Throat swab positive for group A strep initially treated with azithromycin and amoxicillin (interim IV ampicillin 2/2 decreased po intake)
Presentation & Diagnosis
Diagnosis of mycoplasma pna
A minority of patients with M. pneumoniae infection develop mucocutaneous lesions → complex underlying pathophys, w/ exact pathogenesis unknown. (1)
Differential when you see MIRM → aka mucositis with a rash, biopsy is not helpful, hx and clinical appearance are
Supportive care: mIVF (close ins/outs), adequate pain relief, antipyretics, supportive nutrition
Presented to the ED with cold-like symptoms, small sore on his lower lip tx with azithro cf CAP (10/5), desat req O2 and albuterol covered with azithro