Introduction
Reactive infectious mucocutaneous eruption (RIME) is an emerging pediatric mucocutaneous syndrome characterized by prominent mucositis with limited or absent skin involvement and an infectious, rather than drug-induced, etiology. First distinguished from Stevens–Johnson syndrome (SJS), RIME poses diagnostic challenges due to overlapping clinical features. Mycoplasma pneumoniae is the most frequently implicated pathogen, particularly in children, where recognition is critical to avoid misdiagnosis and inappropriate management. Understanding RIME as a distinct clinical entity has significant implications for diagnosis, treatment, and prognosis in pediatric infectious diseases and dermatology research.
Etiopathogenesis and Infectious Triggers
Current evidence highlights M. pneumoniae as the predominant trigger of RIME, with pathogenesis believed to involve immune-mediated mechanisms rather than direct pathogen invasion. Molecular mimicry and immune complex formation are hypothesized contributors to mucosal injury. Recent literature has expanded the spectrum of infectious triggers to include viral and bacterial pathogens, emphasizing RIME as a post-infectious immunologic phenomenon. Research into host susceptibility, immune pathways, and pathogen-specific responses remains crucial to elucidate disease mechanisms.
Clinical Spectrum and Phenotypic Variability
RIME demonstrates marked clinical heterogeneity, ranging from isolated mucositis to multisite involvement of oral, ocular, and genital mucosa, with minimal or variable cutaneous findings. This variability complicates early diagnosis and contributes to confusion with SJS or erythema multiforme. Pediatric case series, including the described male patients aged 2–12 years, illustrate presentations from absent skin lesions to widespread rash, underscoring the need for phenotype-based clinical classification in future research.
Diagnostic Challenges and Differential Diagnosis
Differentiating RIME from SJS is a central clinical and research challenge due to overlapping mucocutaneous features but divergent etiologies and prognoses. Accurate diagnosis relies on thorough clinical assessment, exclusion of drug triggers, and confirmation of infectious etiology through serology or PCR. Research efforts should focus on developing standardized diagnostic criteria and biomarkers to facilitate early recognition and reduce misclassification in both clinical practice and epidemiologic studies.
Management Strategies and Therapeutic Outcomes
Management of RIME is largely supportive and multidisciplinary, involving antimicrobial therapy targeting M. pneumoniae, mucosal care, and systemic treatment for complications such as pneumonia or sepsis. The favorable recovery observed within 10–21 days in reported cases supports the effectiveness of timely intervention. However, variability in disease severity and recurrence highlights the need for clinical trials and consensus guidelines to optimize therapeutic strategies and long-term follow-up.
Prognosis, Recurrence, and Research Implications
Although generally associated with good outcomes, RIME can exhibit a relapsing phenotype, as demonstrated by recurrent hospitalizations in some patients. Long-term sequelae, including post-inflammatory hyperpigmentation or ocular complications, warrant further investigation. From a research perspective, RIME represents an important model of infection-triggered mucocutaneous disease, emphasizing the need for multicenter studies to define epidemiology, recurrence risk, and preventive strategies in pediatric populations.
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