Reactive infectious mucocutaneous eruption: an increasingly encountered complication during periods of increased Mycoplasma pneumoniae transmission—a case report

ABSTRACT Background Mycoplasma pneumoniae is a common cause of community-acquired pneumonia among children and young adults. Surveillance within the United States has identified increased levels of M. pneumoniae -mediated respiratory disease following a multi-year period of minimal detection during the COVID-19 pandemic. A wide spectrum of extrapulmonary complications can be associated with M. pneumoniae infections, including dermatological disease. Reactive infectious mucocutaneous eruption (RIME) is a constellation of immune-mediated extrapulmonary manifestations causing ulceration of multiple mucous membranes that occurs in up to 25% M . pneumoniae cases. Case Summary An adolescent patient presenting with acute hypoxic respiratory failure and an eight-day history of conjunctivitis and oral ulcers tested positive for M. pneumoniae from a nasopharyngeal specimen and was diagnosed with RIME. A retrospective review of increased M. pneumoniae test positivity and hospitalizations at our institution was undertaken, which mirrored national trends. Conclusion As dedicated M. pneumoniae testing may not be available in all settings, clinicians should consider a diagnosis of RIME for patients presenting with similar para- or post-infectious mucositis, even in the absence of traditional respiratory symptoms. RIME incidence is expected to increase in the setting of a higher prevalence of M. pneumoniae disease. As RIME can be associated with significant morbidity including dehydration and weight loss as well as disease recurrence, proper management of patient symptomatology is essential.