An outbreak of reactive infectious mucocutaneous eruption (RIME) after Mycoplasma pneumoniae infections in Sydney, 2024: retrospective case series

Abstract

Reactive infectious mucocutaneous eruption (RIME) is a severe mucocutaneous reaction most frequently seen in children and adolescents after an infectious respiratory illness, particularly Mycoplasma pneumoniae infections.¹ It is characterised by prominent oral mucositis, conjunctivitis, and urethral involvement. Cutaneous manifestations are usually limited; the most frequent are vesicobullous eruptions.² RIME is distinguished from Stevens–Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) because it typically has an infectious cause, a milder course, and a favourable prognosis.¹

In this article, we review the cases of thirteen children with RIME diagnosed by a specialist paediatric dermatologist and managed at the Sydney Children's Hospital at Randwick, a New South Wales referral centre, during 1 March – 31 May 2024. We extracted data and photographs from their medical records with the informed consent of their parents or guardians. The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2024/ETH01030).

The mean age of the thirteen children (eight boys, five girls) was 11.7 years (range: 7–16 years); twelve were polymerase chain reaction (PCR)-positive for M. pneumoniae. The mean length of respiratory illness preceding the mucocutaneous eruption was 7.4 days (range, 5–10 days). Oral manifestations were evident in all thirteen children, including haemorrhagic crusted lips, mucositis, and lip swelling. Seven children had cutaneous symptoms, limited in six to small targetoid lesions or bullae; eight children had ocular conjunctivitis, and four had urethral lesions (Box; Supporting Information).

Open access publishing facilitated by the University of Sydney, as part of the Wiley – the University of Sydney agreement via the Council of Australian University Librarians.

No relevant disclosures.

The data underlying this study are included in the Supporting Information file; electronic medical records are not available for sharing.

Received 8 June 2024, accepted 14 August 2024