Reactive infectious mucocutaneous eruption in children diagnosed with COVID‐19

Abstract

We describe the cases of two immunocompetent children who developed mucositis with oral, ocular, and genital involvement during acute COVID-19 illness. The pattern of mucosal involvement with no other cutaneous involvement was consistent with reactive infectious mucocutaneous eruption (RIME). No other intercurrent infections or new medications were identified, suggesting that COVID-19 was causative. Both patients noted improvement with systemic corticosteroid therapy.

Reactive infectious mucocutaneous eruption in a young-adult with COVID-19

“…Of the cases of RIME secondary to COVID-19 reported in the literature, the majority of patients are male (4 of 5) and all are either teenagers or young adults [5][6][7], as was the case with our patient. None of the cases reported had severe respiratory illness related to Sars-COV-2 infection, including our own.…”

“…Severity of RIME was generally mild, resolving completely after oral or IV corticosteroids, IVIG, or cyclosporine. One patient required total parenteral nutrition due to the severity of oral lesions and prolonged disease course [7].…”

Reactive infectious mucocutaneous eruption triggered by COVID‐19 infection in an adult patient

“…Approximately 11% of patients with COVID‐19 infection have oral involvement, 3 including aphthous‐like lesions, herpetiform lesions and petechiae, as well as red and white plaques. We have found six reported cases of RIME secondary to COVID‐19: five adolescents (ages 14 to 17), 1 , 2 , 4 , 5 and only one adult, a 23‐year‐old woman presenting with recurrent RIME since age 18. Her first episode was triggered by M. pneumoniae , the second by influenza A, and the third by SARS‐CoV‐2.…”

“… 1 The treatment for RIME is merely supportive since it is self‐limited, resolving in 1–3 weeks, although corticosteroids have been indicated in severe cases. 4 In one non‐responding patient, cyclosporine was successfully prescribed. 5 The recurrence rate of RIME is unknown, but MIRM has been reported to recur in up to 8% of patients.…”

Reactive infectious mucocutaneous eruption – repeat etanercept after intravenous immunoglobulin: A case report

“…RIME unifies mycoplasma-induced rash and mucositis (MIRM) and other clinically similar mucosal-predominant eruptions related to a growing number of viral infections, including COVID-19. 2 , 7 – 12 RIME presents with a prodrome of respiratory symptoms during its 2- to 3-week incubation period. Nearly one-quarter of MP pneumonia patients develop mucocutaneous disease, while RIME manifests in 7%.…”