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You are seeing a 12-year-old girl who has had 9 days of cough, fever (maximum temperature 39, but low-grade for the past 3 days), and malaise. This morning, she woke up with oral lesions and a rash. She has not been taking any medications except honey for her cough. Her vitals are temp 37.8, HR 90, RR 22, BP 100/50, pulse oximetry 95% on room air. Pertinent physical exam findings include: rales and occasional expiratory wheezes localized to her right mid and lower lung fields, erosive lesions on her tongue and buccal mucosa and hemorrhagic crusting on her lips, bilateral purulent conjunctivitis, and a few scattered vesiculobullous lesions on her arms, legs, and torso. She has no lesions on her palms or soles.
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January 6, 2026 at 3:39 pm
D) Reactive infectious mucocutaneous eruption (RIME)
RIME is a mucocutaneous reaction that follows a bacterial or viral respiratory infection, most commonly Mycoplasma pneumoniae. It was formerly called Mycoplasma-induced rash and mucositis (MIRM) and Mycoplasma pneumoniae associated mucositis (MPAM). It is more common in children (mean age 12 years), males, and in the winter months. Severe mucositis, commonly involving 2 or more mucosal sites (oral, ophthalmic, genital) present approximately 1 week into a respiratory infection illness. Sparse skin lesions, commonly vesiculobullous or targetoid but also sometimes macular, popular, or morbilliform, occur on the extremities and torso, typically sparing the palms and soles. Treatment includes treating the underlying infection and supportive care (pain management, attention to fluids, and management of mucositis).