SHM Converge Scientific Abstract ePoster Gallery-Beyond the Lungs: A Case of Reactive Infectious Mucocutaneous Eruption (Rime) Following Mycoplasma Pneumoniae Infection

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This case report describes a 26-year-old man with no significant medical history who developed severe oral, ocular, and genital mucositis one week after a febrile respiratory illness. He presented with desquamated plaques and fissuring of the lips, injected conjunctiva with discharge, and erythematous vesicular lesions on the scrotum and urethral meatus. He had not started any new medications, making drug-related causes such as Stevens-Johnson syndrome less likely.<br /><br />Workup showed negative HIV RNA, HSV/VZV testing, sexually transmitted infection testing, and ANCA. Chest CT demonstrated tree-in-bud opacities consistent with pneumonia, and respiratory PCR was positive for Mycoplasma pneumoniae. Dermatology and ophthalmology evaluated the patient and concluded that the presentation was most consistent with reactive infectious mucocutaneous eruption (RIME), a mucositis syndrome triggered by infection, most commonly Mycoplasma pneumoniae.<br /><br />The patient improved significantly after treatment with IV methylprednisolone 1 mg/kg/day for 4 days, followed by a steroid taper. He also received azithromycin 500 mg daily for 3 days for Mycoplasma infection.<br /><br />The report emphasizes that RIME can closely resemble Stevens-Johnson syndrome, toxic epidermal necrolysis, or erythema multiforme, but typically follows a respiratory prodrome and is associated with prominent mucosal involvement. Although RIME is more common in children, adult cases do occur. With rising Mycoplasma pneumoniae rates in the United States, clinicians should recognize RIME in patients with oral, ocular, or urogenital mucosal ulcerations after an upper respiratory illness.

Asset Subtitle

Patricia E. Litkowski

Meta Tag

Author List Malek Ayoub, Patricia E. Litkowski, Sydney Blum

Category Clinical Vignettes

Concept Reactive Infectious Mucocutaneous Eruption

Concept Mycoplasma pneumoniae

Concept Oral Mucosa

Concept Mucositis Syndrome

Concept Ocular Mucosa

Distinguished Non-Finalist

Presenter Organization Washington University in St. Louis

Presenting Author Patricia E. Litkowski

Track Adult

Keywords

reactive infectious mucocutaneous eruption

RIME

Mycoplasma pneumoniae

mucositis

oral ulcerations

ocular involvement

genital lesions

respiratory infection

Stevens-Johnson syndrome

case report

Reactive Infectious Mucocutaneous Eruption

Mycoplasma pneumoniae

Oral Mucosa

Mucositis Syndrome

Ocular Mucosa