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StevenseJohnson syndrome (SJS) is an acute disease characterized by severe inflammation and necrosis of two or more mucosal membranes and systemic symptoms such as fever and malaise.1 SJS has most often been associated with a drug reaction and less frequently with infections such as Mycoplasma.2 While skin manifestation is commonly seen in SJS patients, SJS-like mucositis without skin lesions has been rarely reported. Such cases have been called SJS without skin lesions, Fuchs syndrome or atypical SJS.3 This condition is believed to be a variant of erythema multiforme majus and usually non-life-threatening because of lacking widespread skin involvement. Although there is an opinion that such cases should not be diagnosed as SJS,4 attention should be paid to this variant from the practical view point. Meanwhile, this mucosal condition has been increasingly recognized as having a close association with Mycoplasma infection and is currently known as Mycoplasma pneumoniae-associated mucositis (MPAM).5 Here, we report a rare case of SJS-like mucositis without skin lesions, presenting with severe melena caused by colon membrane involvement. A 44-year-old Japanese female was referred to our hospital (day 0) because of high fever, cough, and sore throat. Seven days prior to our first examination (day-7), she developed conjunctival injection, followed by severe ulceration on the lips and oral mucosa (day-5). She had taken medicines including acetaminophen and codeine phosphate since day-7. A rapid antigen test using swabs from her nasal mucosa was performed with a positive result for influenza type B, and she was given laninamivir on day-4. The patient was admitted to another hospital and all medicines were ceased on day-2, but her eye and mucosal symptoms deteriorated rapidly. On our physical examination, her conjunctiva was hyperemic with marked eye discharge and visual disturbance in both eyes (Fig. 1a). There were painful ulcerative lesions on the lower lip (Fig. 1b) and oral mucosa (Fig. 1c). Her skin and genital mucosa were not affected. Histopathologically, a mucosal biopsy specimen taken from the lower lip showed a mild lymphocytic infiltrate in the upper lamina propria with lymphocytic invasion into the epithelium (Fig. 1d). Ophthalmological consultation indicated typical SJS findings including corneal erosions, pseudmembranes and syncanthus in both eyes. Chest roentogenological examination displayed pneumonia in the right lower lung field. Laboratory examination showed elevated levels of neutrophil count (9048/

Colonic involvement in Stevens–Johnson syndrome-like mucositis without skin lesions