An Observational Study on Mucocutaneous Eruption Secondary to Mycoplasma pneumoniae: Alphabet Soup of Reactive Infectious Mucocutaneous Eruption or Mycoplasma pneumoniae-induced Rash and Mucositis

Background: In 2015, diagnostic criteria for Mycoplasma pneumoniae -induced rash and mucositis (MIRM) were recommended, and currently, reactive infectious mucocutaneous eruption (RIME) is preferred. Due to the relatively recent introduction of this disorder, clinicians are still not extensively primed regarding the morphology and diagnosis of MIRM. Materials and Methods: A retrospective study was undertaken in a referral children’s hospital in Western India over 6 months where children concomitantly affected with M. pneumoniae respiratory illness and mucositis and skin involvement were included and their characteristics were analyzed. Results: Severe mucositis affecting ≥2 mucosae classically associated with a respiratory illness was the norm in all nine patients, but the morphology and distribution of mucocutaneous lesions varied. Oral mucosa was most prevalent followed by ocular mucosa. Nasal and urogenital mucositis was also noted. Cutaneous involvement of <10% body surface area (BSA) was in eight patients, with the remainder reporting BSA involvement of >50%. All cases had confirmed immunoglobulin M antibodies for M. pneumoniae . Resolution of skin lesions took an average of 4.67 days, albeit mucosa took longer. Conjunctival synechiae were seen in one patient. All patients were treated in an inpatient care with supportive management, antimicrobials, and immunomodulatory agents. Conclusion: Children with severe mucositis and sparse cutaneous eruptions especially with concomitant respiratory illness are characteristic of MIRM under the umbrella of RIME. Since their cutaneous morphology and distribution varies, physicians must maintain a high index of suspicion for this diagnosis, as this diagnosis drastically changes the management protocol, prognosis, and resultant counseling of parents.