Advertisement

M. Pneumoniae Is a Potential Trigger for Eosinophilic Esophagitis

      Rationale

      Mycoplasma pneumoniae (MP) is suggested as a trigger of asthma. MP undergoes cyclic epidemics, has increasing macrolide resistance, increases IL-5 and VEGF and contains gene CARDS promoting TH2 inflammation. It has never before to our knowledge been implicated in eosinophilic esophagitis (EOE). We recently treated a 10 year old male for two months of acute onset morning vomiting and cough. He had multiple similarly ill contacts at school. He had failed reflux therapy. EGD showed over 50 eosinophils/HFP in all 3 levels, Ph-impedance probe was normal, MRI of CNS revealed severe pansinusitis. Blood work showed positive 2177 u/ml IgM for MP. Treatment with clarithromycin and topical flovent rapidly improved symptoms. This suggested to us that MP may have been the trigger for him and possibly others with EOE.

      Methods

      Patients treated for EOE in our (NY) practice over this spring-summer (2012) were offered standard serology for MP, with the intention to treat acute cases.

      Results

      1/13 was positive for IgM (with eosinophilic gastritis), 10/12 were positive for IgG including the oldest and youngest patient. MP infection is rare in very young children.

      Conclusions

      Patients with EOE had almost universal serologic evidence of prior MP, but serology can not distinguish past versus active infection. We plan PCR for MP on esophageal biopsies from EOE and controls, and will assess MP-TSLP genetic polymorphism interactions, a proposed mechanism linking infection and atopy.