Reactive infectious mucocutaneous eruption (RIME) secondary to COVID-19 infection

ABSTRACT

A 17-year-old-male presented to an acute medical take with severe mouth pain, and poor oral intake. This occurred 6 days after a positive SARS CoV-2 test, with which he had only mild symptoms. He was unvaccinated against SARS CoV-2. Clinically, he had a severe ulcerated mucositis present on his lips, buccal mucosa and lateral edge of the tongue. He had not been commenced on any new medications prior. There was no other skin involvement. Viral swabs for herpes simplex virus and varicella zoster virus were negative. His presentation was in keeping with a reactive infectious mucocutaneous eruption (RIME) secondary to COVID-19 infection. This typically presents with severe painful mucositis with mild nonspecific skin manifestations. This entity was previously classically described in association with Mycoplasma infection. Since the emergence of COVID-19, several cutaneous manifestations have been observed. There is only one other published case of RIME associated with COVID-19 infection. This was in a similarly aged male presenting with severe mucositis and lack of significant cutaneous involvement. The patient was treated with a 5-day course of 40 mg oral prednisolone, which led to complete resolution with no scarring or subsequent recurrence. A literature review revealed only one other case of RIME associated with COVID-19, which was successfully treated with oral steroid therapy. The case exemplifies new, emerging presentations related to COVID-19 infection that may present to dermatology services.