A 9-year-old male patient, previously healthy.
She consulted due to erythematous papules on the back of her hands, forearms and malformations, very pruritic.
The rest of the physical examination was normal.
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The initial diagnostic impression was Gianotti Crosti syndrome and cetirizine was indicated orally; 72 h later the exanthema progressed, which became erythematous-maculo-papular generalized and confluent.
It involved cheeks, neck, trunk and limbs.
The child presented axillary temperature of 37.8 °C, with decay and regular general condition.
She had congestive fauces, cervical, submaxillary, axillary and inguinal lymphadenopathy without visceromegaly.
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How do you guide your diagnosis?
Simultaneous reception
Erythrodermy was attacked in the first week.
Started with tapesquamation in the ears and neck, in cephalometric direction.
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On the 10th day of evolution the patient developed fever and persistent edema, tense and painful.
Consultation with pediatric urology ruled out testicular involvement and interpreted edema secondary to generalized inflammatory process (capilaritis).
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The scaling was generalized, with scaly skin on an erythrodermic skin; it reached palms and soles and respected scalp.
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What is your diagnosis?
In the context of an exanthema, lymphadenopathies and underestimates the initial clinical suspicion was: infection of viral etiology.
Laboratory tests were requested: hematocrit 38.4%, GB 8.510 (N 54.5/B 0.3/E 15.3/L 19.9/M 10.1).
Eligibility: 2 mm/h.
Hepatogram: GDT: 32 TGP: 23 ALB: 4.3.
Fauces exudate was requested, which was negative, chest X-ray and complete urine, which were normal.
Serology: EBV negative anti- viral capsid IgM, IgM parvovirus negative, HBs Ag negative.
A negative serology for parotiditis (IgM) was added at the request of Urology.
On the tenth day of evolution, reactive serology for Mycoplasma pneumoniae (positive IgM) was received, so treatment with claritomycin 15 mg/kg/day every 12 h for 10 days was immediately initiated.
The response was excellent with disappearance of the fever, improvement in the general condition after 48 h, and slow disappearance of the rash.
Three weeks after the beginning of the process, the child was clearly improved, without palpable lymph nodes, with few areas of erythema on a very xerodermic skin and able to resume school activities.
Diagnosis Exanthema due to Mycoplasma pneumoniae.
Extrapulmonary manifestations of Mycoplasma pneumoniae Mycoplasma pneumoniae is one of the three species of Mycoplasma (Mycoplasma hominis and Ureaplasma urealyticum) that causes disease in humans.
The setting up period is up to three weeks, the building is person-to-person through Flügge gouts and is more frequent in autumn and inconvenience.
It accounts for 20% of pneumonias in children older than 5 years and adolescents and more than 50% in university students.
Extrapulmonary manifestations are an important part of the acute disease caused by Mycoplasma; their frequency is estimated at 10%.
Physiopathogeny is still unclear in many cases: it could be due to an immunological mechanism or to the direct action of Mycoplasma.
In addition to the classic respiratory involvement, Mycoplasma has a broad spectrum of clinical expression: • Haemolysis (60%) • Cutaneous Rash: erythematomaculopapular or vesicular pericarditis; Stevens-Johnson syndrome • Mycoplasma cardiogenic conges:
The diagnosis is clinical.
Serology with indirect immunofluorescence detects IgM specific early and is a very sensitive method to confirm the diagnosis (this is currently performed in our hospital).
The positive result is defined by the presence of IgM or by a triple or higher increase in the serological pair IgG with 15 days difference between the two dosages.
The recommended antibiotic treatment is macrolides or tetra.
In childhood, we preferred maclidos: doses of the following drugs were prescribed for 4 days; clarithromycin for 10 days; clarithromycin for 15 mg/kg/day for 2 days; daily doses for 10 days; and daily doses for 4 days.
The latter two have the advantage of being administered less frequently and producing fewer gastrointestinal effects.
In cases of hemolytic anemia and CNS involvement, the therapeutic role of antibiotics is insufficient, since an immune mechanism is involved in its genesis.
Alternative therapies (steroids, plasmapheresis, diuretics, etc.) are added without the efficacy of any of them being documented.
