Comparative analysis of Mycoplasma Pneumoniae and Drug-induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis in Children

TL;DR

This study compares how children with mycoplasma pneumonia and drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis differ in symptoms, treatment, and outcomes.

Contribution

The study identifies distinct clinical and therapeutic patterns between mycoplasma-induced and drug-induced SJS/TEN in children.

Findings

Children with mycoplasma-induced SJS/TEN were older and had more lung consolidation than drug-induced cases.

Drug-induced SJS/TEN had higher corticosteroid and IVIG use compared to mycoplasma cases.

NSAIDs and Chinese patent medicines were the main sensitizing drugs for drug-induced SJS/TEN.

Abstract

To compare the differences between clinical characteristics, therapeutic management, and prognosis of mycoplasma pneumonia (MP) and drug-induced Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) in children.

This was a retrospective study. The clinical data of SJS and TEN patients admitted to Hebei Children’s Hospital from 2014–2024 were retrospectively analyzed and divided into the MP group and the drug group based on laboratory findings and the ALDEN algorithm for comparative study.

A total of 42 cases were included in the study. Among them, 20 cases were in the MP group and 22 cases were in the drug group. The median age of MP group was 108.0 (54.0, 129.0) months, which was greater than drug group with 42.0 (22.5, 75.0) months, and the difference was statistically significant (P < 0.05). Ten cases (50.0%) in the MP group had chest CT suggestive of consolidation of lung/pleural effusion, which was higher than the two cases (9.1%) in the drug group, with a statistically significant difference (P<0.05). Both groups were given systemic corticosteroids (Cs) treatment, and the proportion of children receiving Cs shock therapy combined with intravenous immunoglobulin (IVIG) in the MP group was significantly lower than that in the drug group, with a statistically significant difference (P<0.05). When SCORTEN score ≧3, the proportion of the MP group receiving Cs shock therapy and IVIG application increased. The median SCORTEN score in both groups was two, corresponding to a predicted mortality rate of 12.2%, whereas all children in the MP group survived and three died in the drug group, with an actual mortality rate of 13.6%.

MP infection and drugs constitute the predominant triggers of SJS/TEN in children, with non-steroidal anti-inflammatory drugs (NSAIDs) and Chinese patent medicines (CPMs) as the main sensitizing drugs. For those with SCORTEN≦2 points, macrolides combined with conventional dose Cs may be the first-line treatment option for them.