Clinical Observation |

Cutaneous Leukocytoclastic Vasculitis and Encephalitis Associated With Mycoplasma pneumoniae Infection

Carlos Perez, MD; Marta Montes, MD
Arch Intern Med. 2002;162(3):352-354. doi:10.1001/archinte.162.3.352.
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Mycoplasma pneumoniae infection is generally associated with respiratory symptoms. Abnormalities in almost every organ system have been described as examples of extrapulmonary manifestations.1 However, skin vasculitis is very rare: we found reports of only 2 cases of serologically confirmed M pneumoniae infection with cutaneous biopsy-proven vasculitis in the English-language literature.2,3 On the other hand, M pneumoniae causes central nervous system complications such as aseptic meningitis, meningoencephalitis, transverse myelitis, brainstem dysfunction, and Guillain-Barré syndrome, as well as many other symptoms.1,4 Three mechanisms for M pneumoniae–associated neurological disease have been postulated: immune-mediated damage, direct invasion of the central nervous system, and production of a neurotoxin by M pneumoniae.4 We report a case of cutaneous leukocytoclastic vasculitis and encephalitis associated with acute M pneumoniae infection. To our knowledge, this association has not been previously reported.

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Figure 1.

Lower extremities of the patient, showing multiple purpuric lesions and ulcerations.

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Figure 2.

Axial T2-weighted magnetic resonance image of the pons, showing an abnormal hyperintense lesion (arrowheads).

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Figure 3.

Photomicrograph of a skin biopsy specimen showing the wall of a dermal venule infiltrated by polymorphonuclear leukocytes and partial obliteration of the lumen (hematoxylin-eosin, original magnification ×20).

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