A unique presentation of reactive infectious mucocutaneous eruption (RIME) and the importance of acute diagnosis.

Abstract

Reactive Infectious Mucocutaneous Eruption (RIME) is a constellation of systemic upper respiratory infectious symptoms preceding mucocutaneous eruption. This case describes RIME following amoxicillin initiation with an otherwise unidentified pathogenic etiology. A previously healthy, fully vaccinated, adolescent male presented for five days of upper respiratory symptoms and was started on empiric amoxicillin therapy due to a family member diagnosed with strep pharyngitis earlier on the same day. Two days later, he developed an oral mucocutaneous eruption, and amoxicillin was discontinued. Within 48 hours of discontinuing amoxicillin, he developed conjunctivitis, stomatitis, and penile lesions. The patient was then hospitalized for mucositis with dehydration. Through exclusion of other etiologies, the patient was diagnosed with mucositis secondary to RIME. RIME has commonly been linked to M. pneumoniae infection; however, our patient had negative infectious assay testing and titers. Limited documentation of post-amoxicillin, aseptic RIME exists, prompting support for an expanded spectrum of disease recognition and timeline documentation.