Reactive Infectious Mucocutaneous Eruption (RIME) in a Teenage Male: Diagnostic Challenges in a Resource-Limited Setting

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia with both pulmonary and extrapulmonary manifestations. Reactive infectious mucocutaneous eruption (RIME) is a recently distinguished, distinct mucocutaneous syndrome characterized by prominent mucositis with or without cutaneous involvement. Differentiating RIME from other severe mucocutaneous conditions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), is critical due to differences in prognosis and management. We report the case of a previously healthy teenage male presenting with a biphasic illness characterized by respiratory symptoms followed by severe mucositis and limited, delayed cutaneous involvement. In a resource-limited setting where confirmatory tests were delayed, diagnosis relied heavily on clinical recognition and multidisciplinary input. The patient was successfully managed with antimicrobial therapy, systemic corticosteroids, and supportive care, resulting in full recovery. This case highlights the critical importance of multidisciplinary care, particularly in complex mucocutaneous syndromes where diagnostic uncertainty exists. RIME should be considered in adolescents presenting with a respiratory prodrome followed by pronounced mucositis and minimal cutaneous involvement. Increased clinician awareness and further prospective studies are needed to establish validated diagnostic criteria and evidence-based treatment guidelines.