A 2 y.o. girl presents with a rash and fever.

What is wrong?

Our patient had a reactive infectious mucocutaneous eruption (RIME). This used to be known as Mycoplasma induced rash but the nomenclature was changed to include other etiologies. Adenovirus, COVID and strep have also been associated with this immune reaction.

RIME is a spectrum of rashes which includes: erythema multiforme, Stevens -Johnson and toxic epidermal necrolysis. (TEN). Kawasaki’s is also associated with a rash.

Mucositis is associated with RIME

Erythema multiforme is an allergic reaction in response to medication, infection or illness and has a classic target lesion but is not associated with mucositis.

The classic target lesion of erythema multiforme

Our patient was treated with steroids and recovered.

Holcomb Z, Hussain S, Huang J, et al. Reactive infectious mucocutaneous eruption associated with SARS-COV-2 infection. JAMA Dermatol 2021 April 7 doi: 10.1001/jama dermatol. 2021.0385.

Miller M, Kamath S. Hughe M, et al. Evaluation of Etanercept for treatment of reactive infectious mucocutaneous eruption. JAMA Dermatol 2021; 157(2):230-232. doi:10.1001/jamadermatol. 2021.5166.

Canavan T, Mathas E, Frieden I, et al. Mycoplasma pneumonia- induced rash and mucositis as distinct from erythema multiforme: A systematic review. 2015, Journal of American Academy of Dermatology Vol 72(2), 239-245 e4.