Toxic epidermal necrolysis due to dual infection of Mycoplasma pneumoniae and Streptococcus complicated by herpes simplex virus

Abstract

Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are severe mucocutaneous reactions, characterized by blistering and epidermal sloughing. They are mainly caused by drugs and less commonly due to infections. A 9-year-old boy presented with fever, cough, atypical target lesions involving >30% of body surface area along with few erosions and positive pseudo-Nikolsky sign. Multiple mucous membranes were involved. Clinical features were consistent with TEN. Radiological and laboratory investigations showed evidence of Mycoplasma pneumonia and Group A Streptococcal infection. The course was further complicated by herpes simplex 1 infection. He responded well to systemic antibiotics, corticosteroids, cyclosporine, acyclovir, and supportive care. This report highlights the occurrence of TEN due to dual infections that further got complicated by a third infection.

Keywords

• erythema multiforme
• mycoplasma pneumoniae
• stevens–johnson syndrome
• streptococcal infections
• toxic epidermal necrolysis