SHM Converge Scientific Abstract ePoster Gallery-Stomatitis? It's Not Always Herpes, Do Some Mental Burpees

Pdf Summary

This case report highlights Reactive Infectious Mucocutaneous Eruption (RIME), a rare inflammatory condition that can mimic herpes gingivostomatitis or Stevens-Johnson syndrome but requires different treatment. RIME is usually triggered by a recent bacterial or viral infection, most often Mycoplasma pneumoniae, and commonly follows about a week of prodromal respiratory symptoms before mucosal and skin findings appear.<br /><br />The patient was an 8-year-old boy with 8 days of cough, nasal congestion, and fever, followed by worsening lip swelling, crusting, peeling, and bleeding that led to poor oral intake and dehydration. He was initially treated for presumed oral herpes with impetigo superinfection, but his hemorrhagic lip lesions worsened and he developed new vesiculobullous lesions near the eye and ears, as well as erosions of the urethral meatus. He also had a persistent wet cough and trismus. Testing was positive for rhino/enterovirus and negative for HSV, and chest X-ray was unremarkable. These findings supported a diagnosis of RIME.<br /><br />He was treated with methylprednisolone and azithromycin, with significant clinical improvement. At dermatology follow-up 8 days later, only minor lip erosions remained.<br /><br />The report emphasizes that hemorrhagic lip crusting should prompt a broad differential diagnosis, including RIME. Key distinguishing features are its infectious trigger, involvement of multiple mucosal sites, sparse or mild skin lesions, and negative Nikolsky sign. Early recognition is important because systemic corticosteroids are the mainstay of treatment and can prevent complications.

Asset Subtitle

Jessica L. Guidici

Meta Tag

Author List Amaya Martinez Mesa, Caroline M. Mebane, Jessica L. Guidici, K'Shylah Whitehurst

Category Clinical Vignettes

Concept Reactive Infectious Mucocutaneous Eruption

Concept Herpes Simplex Virus Gingivostomatitis

Concept Stevens-Johnson Syndrome

Concept Mycoplasma pneumoniae

Concept Systemic Corticosteroid

Distinguished Non-Finalist

Presenter Organization University of North Carolina Hospitals

Presenting Author Jessica L. Guidici

Track Pediatric

Keywords

Reactive Infectious Mucocutaneous Eruption

RIME

hemorrhagic lip crusting

Mycoplasma pneumoniae

mucosal involvement

pediatric case report

systemic corticosteroids

azithromycin

herpes gingivostomatitis differential

Stevens-Johnson syndrome

Reactive Infectious Mucocutaneous Eruption

Herpes Simplex Virus Gingivostomatitis

Stevens-Johnson Syndrome

Mycoplasma pneumoniae

Systemic Corticosteroid