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

Víctor García Rodríguez; Maribel Iglesias  Sancho; Albert Martin  Poch; Maria Teresa  Fernández Figueras; Montserrat  Salleras Redonnet

doi:10.5826/dpc.1503a5083

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

Authors

Víctor García Rodríguez Dermatology Department, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud, Barcelona (Barcelona), Spain.
Maribel Iglesias Sancho Dermatology Department, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud, Barcelona (Barcelona), Spain https://orcid.org/0000-0001-8982-8522
Albert Martin Poch Dermatology Department, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud, Barcelona (Barcelona), Spain
Maria Teresa Fernández Figueras Pathology Department, Hospital Universitari General de Catalunya, Grupo Hospitalario Quirónsalud, Sant Cugat del Vallés, Barcelona (Spain) https://orcid.org/0000-0002-2366-7110
Montserrat Salleras Redonnet Dermatology Department, Hospital Universitari Sagrat Cor, Grupo Hospitalario Quirónsalud, Barcelona (Barcelona), Spain. https://orcid.org/0000-0003-1004-2493

Keywords:

reactive infectious mucocutaneous eruption, mucocutaneous eruptions, mycoplasma-induced rash and mucositis, RIME, MIRM

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

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