SHM Converge Scientific Abstract ePoster Gallery-No Rime or Reason: Why Is My Mouth Sore?

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This case describes a 22-year-old man with severe oral ulcers and pain after a recent respiratory illness. He developed cough and sore throat, followed by worsening oral erosions and mucositis that made eating and speaking difficult. On exam, he had fever, low oxygen saturation, bilateral conjunctivitis, and extensive oral sloughing, but no skin rash. Initial workup was negative for HSV, varicella zoster, and blood culture infection, while a nasal viral swab was positive for <em>Mycoplasma pneumoniae</em>.

The patient was diagnosed with reactive infectious mucocutaneous eruption (RIME), a severe mucosal inflammatory syndrome triggered by infection. RIME commonly affects children and adolescents but can occur in adults. It may involve the mouth, eyes, and genital or rectal mucosa, and is most often associated with <em>Mycoplasma</em> infection. Because oral ulcers have a broad differential—including HSV, aphthous ulcers, autoimmune blistering disease, Stevens-Johnson syndrome, and toxic epidermal necrolysis—prompt recognition is important.

He was treated with IV steroids, steroid mouthwash, and azithromycin. His mucositis improved over three days, and he was discharged on an oral steroid taper. The case highlights the importance of distinguishing RIME from other causes of mucositis so that timely treatment and recovery can occur.

Asset Subtitle

Alisse Singer

Meta Tag

Author List Alex Truong, Alisse Singer, Sherry Zhang

Category Clinical Vignettes

Concept Oral Ulcer

Concept Reactive Infectious Mucocutaneous Eruption

Concept Differential Diagnosis

Concept Mycoplasma pneumoniae

Concept Respiratory Infection

Distinguished Non-Finalist

Presenter Organization UC San Diego Health

Presenting Author Alisse Singer

Track Adult

Keywords

reactive infectious mucocutaneous eruption

RIME

Mycoplasma pneumoniae

oral ulcers

mucositis

conjunctivitis

respiratory infection

steroids

azithromycin

Stevens-Johnson syndrome

Oral Ulcer

Reactive Infectious Mucocutaneous Eruption

Differential Diagnosis

Mycoplasma pneumoniae

Respiratory Infection