Reactive infectious mucocutaneous eruption in children diagnosed with COVID-19

ABSTRACT

We describe the cases of two immunocompetent children who developed mucositis with oral, ocular and genital involvement during acute COVID-19 illness. Patient 1 was a 17-year-old male and patient 2 was a 14-year-old male. Both patients presented approximately one week following onset of fever and cough, and subsequent positive SARS-CoV-2 polymerase chain reaction (PCR) test. They each developed conjunctivitis and ulceration of oral mucosa, and erythematous circumferential erosions of the glans penis, with no other cutaneous findings within 10 days of initial systemic symptoms. No other intercurrent infections, including herpes simplex virus 1/2 PCR viral swabs or new medications, were identified, suggesting that COVID-19 was causative. Following dermatology consultation, both patients were diagnosed with SARS-CoV-2-associated reactive infectious mucocutaneous eruption (RIME). Both patients were treated with intravenous hydrocortisone, betamethasone valerate 0.1% ointment once daily, analgesia and intravenous hydration. Both patients noted improvement with systemic corticosteroid therapy. Patient 1 was discharged after 4 days and Patient 2 after 14 days as his severe mucosal ulceration was impacting his oral intake. He had complete resolution of mucositis one week after discharge. The term RIME describes the clinical presentation of significant mucositis (oral, ocular, and anogenital) that is absent to sparse cutaneous involvement, typically occurring as a late manifestation of exposure to Mycoplasma and other infectious agents. The combination of recent PCR-confirmed SARS-CoV-2 infection, absence of other contemporaneous laboratory- confirmed infections and prominent mucositis suggests SARS-CoV-2 as an infectious trigger for RIME in both patients. Clinicians should be aware that SARS-CoV-2 can precipitate RIME and that systemic corticosteroids may provide benefit.