Mycoplasma Pneumoniae-Associated Stevens-Johnson Syndrome Exhibits Lymphopenia And Redistribution of CD4+ T Cells

Abstract: Erythema multiforme (EM) is an immune-mediated disease categorized into EM minor and EM major, also called Stevens-Johnson syndrome. The presence of mucosal involvement differentiates erythema multiforme major from erythema multiforme minor. Many drugs and agents can induce Stevens-Johnson syndrome. We report a case of Stevens-Johnson syndrome associated with Mycoplasma pneumoniae infection. Lymphopenia with a significant decrease of CD4+ T cells in the blood and predominant CD4+T cells in the skin vesicular fluid was found. The improvement of lymphopenia was associated with disease recovery. In a retrospective chart review of patients treated in our hospital over the past 3 years, we found that 5 patients with Stevens-Johnson syndrome all had lymphopenia (＜ 1.50 x 1000000000 / L; average 0.99 x 1000000000 / L), whereas 13 other patients with erythema multiforme minor demonstrated normal normal lymphocyte counts (average 3.13 x 1000000000 / L), with the exception of one patient with herpes infection showing lymphopenia. These results suggested that an immunopathogenesis involving redistribution of CD4+T cells might contribute to the development of Stevens-Johnson syndrome. Further studies to investigate the involvement of CD4+T cells in Stevens-Johnson syndrome may implicate a specific strategy to prevent fatal Stevens-Johnson syndrome.

並列關鍵字

Erythema multiforme ； Stevens-Johnson syndrome ； Mycoplasma infections ； CD4-positive T-lymphocytes ； Lymphopenia

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