Approach to Diagnosis and Management of Reactive Infectious Mucosal Eruption (RIME)
Abstract
Mycoplasma pneumoniae (MP) induced rash and mucositis (MIRM), also known as reactive infectious mucosal eruption (RIME), was first described as a distinct entity in 2015. This condition has historically been under the diagnostic umbrella of erythema multiforme, and within the spectrum of Steven’s Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). RIME/MIRM is, however, a separate entity with distinct clinical features requiring a specific approach to providing accurate diagnosis, treatment and optimize patient outcomes.
Mycoplasma pneumoniae is a bacterial infection that is a common cause of community acquired pneumonia in children over 5 years of age and adolescents. In addition to respiratory findings, MP is also known to have a number of extra-pulmonary manifestations and has been identified as a cause of significant mucositis and cutaneous rash in the pediatric population and less commonly in adults. Other infectious triggers have also been identified in cases of RIME and include Chlamydophila pneumonia, Influenza B, and a number of other respiratory viruses.
References
Canavan TN, Mathes EF, Frieden I, Skinkai K. Mycoplasma pneumonia-induced rash and mucositis as a syndrome distinct from Stevens-Johnson syndrome and erythema multiforme: A systematic review. J Am Acad Dermatol. 2015;72(2):239-245.
Jain S, Williams DJ, Arnold SR et al. Community acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 2015;372:835-45.
Bradley JS, Byington CL, Shah SS et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53:e25-76.
Ramien ML. Reactive infectious mucosal eruption: Mycoplasma pneumonia-induced rash and mucositis and other parainfectious eruptions. Clin Exp Dermatol. 2021;46:420-429.
John SD, Ramanthan J, Swischuk LE. Spectrum of clinical and radiographic findings in pediatric mycoplasma pneumonia. RadioGraphics. 2001;21:121-131.
Poyhonen H, Nurmi M, Peltola V, Alaluusua S, Ruuskanen O, Lahdesmaki T. Dental staining after doxycycline use in children. J Antimicrob Chemother. 2017;72:2887-2890.
Meyer Sauteur PM, Goetschel P, Lautenschlager S. Mycoplasma pneumonia and mucositis-part of the Stevens-Johnson syndrome spectrum. J Dtsch Dermatol Ges. 2012;10:740-746.
Michaels B. The role of systemic corticosteroid therapy in erythema multiforme major and Stevens-Johnson syndrome: a review of past and current opinions. J Clin Aesthet Dermatol. 2009;2:51-55.
Li HOY, Colantonio S, Ramien ML. Treatment of Mycoplasma pneumoniae-induced rash and mucositis with cyclosporine. J Cutan Med Surg. 2019;23:608-612.
Liakos W, Xu A, Finelt N. Clinical features of recurrent Mycoplasma pneumoniae-induced rash and mucositis. Pediatr Dermatol. 2021;38(1):154-158.
