Reactive Infectious Mucocutaneous Eruption (RIME): Narrative Review and Proposed Management Algorithm

Abstract

Introduction: RIME is an emerging dermatologic condition marked by prominent mucositis with minimal skin involvement, often mimicking Stevens-Johnson syndrome. While initially linked to Mycoplasma pneumoniae, a broader range of infectious triggers is now recognized. Objectives: We present a narrative review of this entity. A proposed diagnostic and therapeutic algorithm is also provided to aid clinicians in clinical practice. Methods: We performed a narrative review of English-language literature on RIME and MIRM indexed in PubMed through 2024, supplemented by clinical insights from the experience of our centre. Results: Evidence regarding treatment is lacking, with systemic steroids and/or cyclosporine A showing the most benefit. RIME usually portends a good prognosis, with recovery within seven to 21 days, although complications can occur. Recurrences are rare, and subsequent episodes can be triggered by different microorganisms. Conclusions: RIME represents a distinct clinical entity with a broadening range of infectious triggers beyond Mycoplasma pneumoniae. Prompt recognition, accurate differentiation from mimickers, and a structured diagnostic and therapeutic approach are essential for effective management and improved patient outcomes.