Ocular Manifestation of Mycoplasma-Induced Rash and Mucositis: A Case Series of Five Patients

PURPOSE: To characterize the ocular manifestations, management, and outcomes of mycoplasma-induced rash and mucositis (MIRM) in a pediatric population. METHODS: Retrospective consecutive case series at a tertiary care pediatric center (Children's Hospital of Eastern Ontario) between July 2023 and October 2024. Inclusion criteria required a clinical diagnosis of MIRM, PCR-confirmed Mycoplasma pneumoniae, and ophthalmology consultation. Patients with Stevens-Johnson syndrome/toxic epidermal necrolysis were excluded. RESULTS: Five patients (4 male; median age 11 years, range 11-13) were included. All presented with a prodromal respiratory illness a median of 7 days prior to mucocutaneous onset. A novel finding of bilateral peripheral, perilimbal-sparing conjunctivitis was observed in all five patients. No patient developed chemosis, symblepharon, pseudomembrane formation, corneal involvement, or anterior chamber inflammation. Best-corrected visual acuity was largely preserved (range 20/20 to 20/40). All patients required hospitalization (median 7 days) with interdisciplinary management. Ocular treatment varied across patients, ranging from topical steroid-antibiotic drops and fluorometholone to artificial tears and observation; all patients also received systemic therapy (prednisone or cyclosporine). Complete ocular recovery without sequelae was achieved in all five patients at follow-up (range 15-40 days). CONCLUSIONS: This series describes a novel topographic pattern of peripheral, perilimbal-sparing conjunctivitis in MIRM, potentially reflecting preferential autoimmune targeting of goblet-cell-rich conjunctival regions and serving as a clinical discriminator from SJS/TEN. Spontaneous ocular recovery supports MIRM's comparatively benign ocular prognosis. The optimal topical management strategy warrants further investigation.