Race for the Case answers

Diagnose this new case by Samantha Bizimungu, MD

A 10-year-old boy with no medical history presented to the emergency department for a one-week history of fever, cough, and odynophagia. Upon evaluation, he was found to have bilateral purulent conjunctivitis, hemorrhagic crusting of the vermilion lips, discrete scattered vesicles on the dorsal hands, and significant dysuria requiring urinary catheterization. A chest radiograph showed bronchial wall thickening.

1. What is the most likely diagnosis, and what is the most likely causal agent?

Answer: Reactive infectious mucocutaneous eruption (RIME). This case of mucositis and rash in a child with a respiratory infection should point to the diagnosis of RIME. Mycoplasma pneumoniae, a leading cause of community-acquired pneumonia, is the most common trigger for RIME.

“Mycoplasma pneumoniae-induced rash and muсоsitiѕ” (ΜІRΜ) is also an acceptable answer.

2. What other conditions can be considered in the differential diagnosis of mucositis and rash in a child?

Answer: The differential diagnosis of mucositis and rash in a child includes: erythema multiforme, Stevens-Johnson syndrome/toxic epidermal necrolysis (ЅJЅ/ΤΕΝ), hand, foot, and mouth disease, Kawasaki disease, and autoimmune bullous diseases such as pemphigus vulgaris.

3. Name three systemic treatment options in adjunct to antibiotic therapy.

Answer: Although there is no evidence-based established treatment for RIME, systemic agents commonly used in the management of this condition include systemic corticosteroids, cyclosporine, intravenous immune globulin (IVIG), and TNF inhibitors such as etanercept.

4. What is the typical clinical course and prognosis of this condition?

Answer: The prognosis of RΙMΕ is generally good, with a low mortality rate and most patients making a full recovery. However, mucocutaneous sequelae can occur in up to 10% of patients. These include post-inflammatory dyspigmentation and genital and ocular synechiae and scarring. There have also been reported cases of recurrence of RIME with subsequent viral or bacterial infections.