Pediatr Infect Vaccine.  2016 Apr;23(1):67-71. 10.14776/piv.2016.23.1.67.

A Case of Erythema Nodosum Associated with Mycoplasma pneumoniae Infection: Pathologic Findings and a Presumed Pathogenesis

• Ju HY
• Kim GY
• Choi SH

• KMID: 2163226
• DOI: http://doi.org/10.14776/piv.2016.23.1.67

Abstract

Erythema nodosum (EN) is a painful skin disease characterized by erythematous tender nodules located predominantly over the extensor aspects of the legs. Various etiological factors, including infection, drug administration, and systemic illness have been implicated as causes of EN. Mycoplasma pneumoniae is one of rare infectious agents to cause EN in children. We report a case of a 7-year-old boy with context of respiratory illness and skin lesions with arthralgia. From stepwise approaches, IgM antibody against M. pneumoniae was positive with titers of 12.18, consistent with respiratory infection of M. pneumoniae and histopathology showed findings of septal and lobular inflammation without vasculitis consistent with EN. In addition, we reviewed the pathogenesis of this disease based on our case and the previous reports.

Keyword

Erythema nodosum; Mycoplasma pneumoniae; Type IV hypersensitivity; Pathogenesis

MeSH Terms

Arthralgia
Child
Erythema Nodosum*
Erythema*
Humans
Hypersensitivity, Delayed
Immunoglobulin M
Inflammation
Leg
Male
Mycoplasma pneumoniae*
Mycoplasma*
Pneumonia
Pneumonia, Mycoplasma*
Skin
Skin Diseases
Vasculitis
Immunoglobulin M

Figure

• 

  Fig. 1. Scattered erythematous subcutaneous nodules located on pretibial surface of lower extremities.

• 

  Fig. 2. There is septal (thick arrow) and lobular (thin arrow) inflammation composed of lymphocytes mixed with histiocytes. (A, H&E stain, X 40). There is a non-caseating small granuloma (circle) composed of ephithelioid histiocytes and surrounded by lymphocytes at septa of adipose tissue. No vasculitis is observed. (B, H&E stain, X 200).

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