Reactive infectious mucocutaneous eruption in Child
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Synopsis
RIME secondary to M pneumoniae (ie, MIRM):
- Usually seen in children and adolescents (mean age of approximately 12 years); however, adults of middle age and younger individuals may also be affected.
- Cases occur more commonly in males than females (ratio of 2:1).
- Prodromal symptoms of cough, fever, and malaise precede mucocutaneous manifestations by approximately a week. Mucositis is a prominent feature and is usually associated with a sparse, polymorphic eruption.
- Complications may include hematemesis, epiglottitis, subcorneal pustulosis, pneumomediastinum, pericardial effusion, and hepatitis.
- Ocular sequelae include conjunctival shrinkage, corneal ulceration, blindness, synechiae, dry eyes, and loss of eyelashes. Oral or urogenital adhesions are less common. Pulmonary complications such as restrictive lung disease and chronic obliterative bronchitis have also been observed in MIRM patients.
- MIRM is very rarely fatal and has a reported mortality rate of 3%, occurring in cases with significant respiratory disease. Most patients make a full recovery, and both long-term complications and recurrences are infrequent.
Codes
ICD10CM:B96.0 – Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere
SNOMEDCT:
406595002 – Infection caused by Mycoplasma pneumoniae
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Differential Diagnosis & Pitfalls
SJS / TEN- The cutaneous involvement of RIME tends to be much less extensive than in SJS and TEN (<10% of body surface area is usually affected).
- The cutaneous lesions of RIME are usually distributed in acral regions compared to SJS and TEN, which exhibit a more central distribution of lesions.
- The desquamation associated with SJS and TEN is absent in RIME (Nikolsky sign is negative).
- RIME has a much milder course than SJS and TEN, eg, ICU admission is less commonly required.
- Absence of exposure to a culprit drug favors RIME, as most cases of SJS and TEN are drug-related.
- Evidence of atypical pneumonia, including respiratory symptoms, lung auscultation findings, M pneumoniae serology, polymerase chain reaction (PCR), and chest x-ray results, may help support RIME diagnosis.
- The classic target lesions occurring in an acral distribution that are typical of EM are less common in RIME.
- Unlike EM, cutaneous lesions may be absent in RIME.
- Evidence of atypical pneumonia, including respiratory symptoms, lung auscultation findings, M pneumoniae serology, PCR, and chest x-ray results, may help support RIME diagnosis.
- Typical round morphology is diagnostic.
- RIME lacks a temporal relationship to drug exposure.
Multisystem inflammatory syndrome in children (MIS-C)
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Last Reviewed:02/14/2022
Last Updated:02/15/2022
Last Updated:02/15/2022
Reactive infectious mucocutaneous eruption in Child