Mucocutaneous Eruption Research Articles

Pediatric dermatologic emergencies.

Provide an overview of recent findings and recommendations for the presentation, diagnosis, and management of pediatric dermatologic emergencies. Updated information on optimal diagnosis and treatments for pediatric dermatologic emergencies because of infection, reactive infectious mucocutaneous eruption, and serious cutaneous adverse reactions are covered. Pediatric dermatologic emergencies require prompt diagnosis and management. This review covers new agents and techniques for management and diagnosis.

An outbreak of reactive infectious mucocutaneous eruption (RIME) after Mycoplasma pneumoniae infections in Sydney, 2024: retrospective case series.

An outbreak of reactive infectious mucocutaneous eruption (RIME) after Mycoplasma pneumoniae infections in Sydney, 2024: retrospective case series.

Oral manifestations of COVID-19 in children: a narrative literature review

COVID-19 triggers an acute inflammatory response in organs, tissues, tongue mucosa, and salivary glands. Some symptoms such as lesions on the tongue and oral mucosa, oral pseudomembranous candidiasis, pharyngitis, taste alteration, gingivitis, canker sores, and even multisystem inflammatory syndrome have been reported in children with COVID-19. Early diagnosis of oral manifestations improves patients' prognosis and quality of life. A narrative literature review was conducted based on studies published in PubMed and LiLacs from January 2020 to April 2024, related to oral manifestations in COVID-19 in children. Of the 68 articles found, 7 were selected after analysis. The main manifestations presented were: abscesses, mucositis, ulcerative lesions, gingivitis, pseudomembranous candidiasis, mucosal lesions, lip and tongue fissures, hemorrhagic crust, inflammation of salivary glands, lip swelling, and reactive infectious mucocutaneous eruption. The selected articles showed that these oral manifestations of COVID-19 can affect children in various age groups, serving as indicators of the disease and signs of worsening infection.

Reactive Infectious Mucocutaneous Eruption with Extensive Cutaneous Involvement

Abstract Recently, there has been discussion to reclassify pediatric Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) as drug-induced epidermal necrolysis (DEN), separating it from infectious etiologies and redefining pediatric mucocutaneous eruptions as either reactive infectious mucocutaneous eruption (RIME) or DEN. In this report, we describe a previously healthy 4-year-old girl with rapidly progressive mucocutaneous blistering involving four mucosal membranes and 37.5% of total body surface area (BSA) following a prodromal rhinovirus and enterovirus infection. The symptoms occurred in the absence of an inciting medication and improved with only supportive care. This case illustrates a rare occurrence of RIME with TEN-like BSA involvement, prompting a review of the literature exploring the relationship between BSA involvement in RIME and its influence on patient outcomes. Findings support the proposed reclassification of SJS/TEN as DEN and postinfectious mucocutaneous eruptions as RIME.

Mucositis y exantema, ¿qué hay de nuevo? Erupción mucocutánea infecciosa reactiva

Reactive infectious mucocutaneous eruption (RIME) is a recently emerged term that describes cases of post-infectious mucositis associated with different etiological agents (viral and bacterial). It is part of the spectrum of Stevens-Johnson syndrome (SSJ) / toxic epidermal necrolysis (NET), although it presents with milder symptoms, with predominantly mucosal involvement. Treatment consists of supportive measures, and may include targeted antibiotic therapy and systemic corticosteroid therapy in cases with extensive involvement.

Updates on postinfectious skin rashes in pediatric dermatology.

This review provides updates on postinfectious skin rashes in the pediatric population from recently published literature. The COVID-19 pandemic and its sequelae remain a focus of research on pediatric infectious skin rashes. Multisystem inflammatory syndrome in children (MIS-C) and reactive infectious mucocutaneous eruption (RIME) are common complications of infection with SARS-COV-2 in the pediatric population. Most cases of MIS-C show low mortality and suggest mucocutaneous symptoms do not correlate with COVID-19 disease severity. Cases of papular acrodermatitis of childhood, also known as Gianotti-Crosti, have also been reported in association with SARS-COV-2, and can present similarly in reaction to other viral infection like molluscum contagiosum, known as a Gianotti-Crosti syndrome-like reaction (GCLR). Other relevant studies on postinfectious skin rashes include updates on the management of staphylococcal scalded skin syndrome (SSSS), with newer evidence advocating for beta-lactam monotherapy without clindamycin and reduced ancillary testing. Finally, the emergence of antifungal resistance due to Trichophyton indotinae is a growing global health concern emphasizing the need for improved antifungal stewardship. It is prudent for clinicians to be informed of both common and rare diagnoses that have emerged more recently in association with the COVID-19 pandemic, in addition to other diseases with newer evidence-based recommendations to guide management.

Abstract PO2-20-07: A case report of a severe cutaneous adverse event in triple negative breast cancer treated with chemoimmunotherapy

Abstract Introduction Cutaneous adverse events related to immune checkpoint inhibitors (ICI) are common and most are mild. However, numerous case reports have documented severe ICI-related skin-toxicities such as Stevens-Johnsons Syndrome (SJS) most commonly among patients with melanoma and lung cancer as immunotherapy has now become a mainstay of treatment in these tumors. The use of ICIs in breast cancer treatment has only recently become standard of care for treatment of metastatic and high risk early-stage triple negative breast cancer with the publication of two landmark clinical trials, KEYNOTE-355 and KEYNOTE-522, respectively. While these trials report low rates of severe skin reactions, little is known about ICI-related severe skin toxicities in patients with breast cancer. Case description A 58-year-old female with clinical stage IIB (cT2N0M0) triple negative breast cancer was undergoing neoadjuvant treatment with pembrolizumab, an anti-programmed death (PD-1) monoclonal antibody, coupled with a chemotherapy back-bone of 12 weekly treatments of carboplatin and paclitaxel followed by 4 cycles of doxorubicin and cyclophosphamide. She developed an erythematous and itchy rash on the right breast and axilla approximately 61 days into her treatment course after having received her fourth dose of pembrolizumab. Over the next 10 days, she developed progression of the rash with painful red papules coalescing into reticulated plaques and dusky blistering of the skin involving the right arm, axilla, abdomen, inguinal folds, thigh, and back, totaling < 10% total body surface area. Notably, the rash did not have mucosal involvement. She was hospitalized for close monitoring and treatment. A punch biopsy of the rash revealed interface dermatitis with areas of full thickness skin necrosis consistent with erythema multiforme, SJS, toxic epidermal necrolysis (TEN), or a fixed drug eruption. Her skin continued to slough in the distribution of rash and a diagnosis of SJS was made. The patient had no response to initial treatment with high dose steroids. Cyclosporine was added, resulting in rapid improvement of her rash. The patient’s neoadjuvant treatment was stopped given the grade 3 SJS she experienced. Despite this truncated neoadjuvant treatment, she had excellent clinical response as her tumor was no longer palpable. She proceeded with a partial mastectomy and sentinel lymph node biopsy. Pathology revealed a pathological complete response. She did not receive any further systemic therapy in the adjuvant setting. Three months later, she was evaluated in clinic without evidence of SJS on physical exam. She was rapidly tapered off cyclosporine over one week without recurrence of her rash. Discussion Severe cutaneous adverse events related to ICIs remains an emerging area of study. In SJS, drug-specific CD8+ T lymphocytes utilize granulysin to mediate keratinocyte apoptosis. It is hypothesized that the blocking of the PD-1/PD-L1 interaction by ICIs results in the disruption of T-cell homeostasis leading to self-directed cytotoxic and inflammatory reactions and ultimately epidermal detachment. In contrast, Molina et al 2020 postulate that such ICI-related skin reactions may represent a separate clinical entity from SJS. In their case report of seven patients, they propose the term “progressive immunotherapy-related mucocutaneous eruption” (PIRME), which the authors suggest is characterized by delayed symptom onset, mild initial presentation, rare ocular involvement, benign clinical course, and favorable treatment response. Further characterization of ICI-related cutaneous adverse events is needed to understand the disease course, optimal treatment, and importantly, implications for re-challenging patients with immunotherapy. Clinicians taking care of breast cancer patients treated with ICIs need to be educated to recognize the associated skin toxicities as patients can rapidly worsen without appropriate treatment. Citation Format: Annie Zhang, Mara Beveridge, Bahar Moftakhar. A case report of a severe cutaneous adverse event in triple negative breast cancer treated with chemoimmunotherapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-20-07.

Atipicità dell’infezione da Mycoplasma: non sempre e non solo polmonite

Here we describe extra-pulmonary involvement of paucisymptomatic pneumonia in an adolescent boy with Mycoplasma pneumoniae infection. Major signs and symptoms were related to cutaneous and mucosal involvement: sparse cutaneous lesions with glans excoriation, inability to tolerate food due to oral mucositis, conjunctivitis. The diagnosis was complex because this disease has clinical presentation similar to other diseases such as Drug Hypersensitivity Reactions (DHRs), erythema multiforme, toxic epidermal necrolysis, Steven-Johnson syndrome, which are disorders with a serious and sometimes fatal course. The aim of the article is to shed light on reactive infection mucocutaneous eruptions, and to present the diagnostic criteria that allow to identify the Mycoplasma-related form (which is still underestimated to date) in order to avoid inadequate treatments, given its generally good prognosis.

Recurrent reactive infectious mucocutaneous eruption (RIME) secondary to Chlamydophila pneumoniae infection in an adult.

The terminology surrounding the clinical syndrome characterized by acute mucositis with minimal skin involvement has been a subject of debate over time. In recent years, terms such as mycoplasma-induced rash and mucositis and reactive infectious mucocutaneous eruption (RIME) have been introduced to encompass milder mucocutaneous diseases associated with respiratory infections, with implications for management and prognosis. We report the first case of recurrent RIME associated with Chlamydophila pneumoniae infection in an adult patient. RIME is likely underreported due to misclassification and a lack of testing for potential pathogens. Early recognition of recurrent RIME is of particular interest from the patient's perspective to reduce the frequency and duration of hospital admissions.

44181 Reactive infectious mucocutaneous eruption secondary to Covid-19 infection

44181 Reactive infectious mucocutaneous eruption secondary to Covid-19 infection

COVID-19 associated severe mucocutaneous blistering eruptions: A case series.

Mucocutaneous eruptions are associated with numerous infectious processes and can present as erythema multiforme (EM), reactive infectious mucocutaneous eruption (RIME), Stevens Johnson syndrome (SJS), or toxic epidermal necrolysis (TEN). Limited reports have detailed the association of these eruptions with SARS-CoV-2 infection. We present a series of eight cases of severe mucocutaneous blistering eruptions associated with SARS-CoV-2 infection. A retrospective case series was performed at six tertiary medical centers from March 1, 2020 to August 1, 2022. Inclusion criteria were met with a clinical diagnosis of EM, RIME, SJS, or TEN and a positive SARS-CoV-2 test (rapid antigen or polymerase chain reaction) less than 4 weeks prior to onset of dermatologic manifestation. Data was collected at time of each patient encounter. Eight patients met criteria with six pediatric patients (<18 years of age) having a median age of 15 years and two adult patients (>18 years of age) having a median age of 36 years. Patients were found to have a clinical diagnosis of RIME in 85.7% of cases. Oral mucosal involvement was the most common clinical finding (100%), followed by ocular (50.0%), urogenital (50.0%), and skin (37.5%) involvement. Evaluation did not reveal any additional infectious triggers in four patients. Evidence of possible concurrent or previous infectious triggers were identified in four patients. This case series highlights the development of severe mucocutaneous eruptions in association with COVID-19 infection, as well as the potential contributing role of concurrent or prior infections.

Reactive infectious mucocutaneous eruption in association with COVID-19 infection in an adult patient.

Reactive infectious mucocutaneous eruption in association with COVID-19 infection in an adult patient.

Reactive infectious mucocutaneous eruption secondary to SARS‐CoV‐2 and influenza A coinfection with varicella zoster virus reactivation

AbstractReactive infectious mucocutaneous eruption (RIME) is a newly proposed clinical entity characterised by post‐infectious mucositis involving two or more mucous membranes. The term expands the previously described Mycoplasma pneumoniae‐induced rash and mucositis to include additional infectious agents. We report a case of RIME secondary to SARS‐CoV2 and Influenza A coinfection with subsequent reactivation of varicella zoster virus on the lips. RIME can have significant clinical overlap with Stevens‐Johnson Syndrome and differentiation is key in limiting unnecessary future medication restrictions on patients. This report serves to increase awareness of RIME, including to coinfections and possible reactivation of Human Herpes Viruses.

505 Distinguishing progressive immunotherapy-related mucocutaneous eruption vs traditional Stevens-Johnson syndrome: An international case-control study

505 Distinguishing progressive immunotherapy-related mucocutaneous eruption vs traditional Stevens-Johnson syndrome: An international case-control study

Recurrent reactive infectious mucocutaneous eruption: A retrospective cohort study

Recurrent reactive infectious mucocutaneous eruption: A retrospective cohort study

A case report of allopurinol-induced toxic epidermal necrolysis with colonic involvement requiring subtotal colectomy

Stevens–Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) represent two ends of a disease spectrum characterised by diffuse mucocutaneous eruptions, affecting the skin, and the ocular, oral and genital mucosal surfaces.1 They constitute a medical emergency associated with significant morbidity and mortality.2 Medications represent the most common cause of SJS/TEN in adults.2 Clinical awareness is important for early diagnosis and the cessation of causative agents, to achieve favourable patient outcomes.

Syphilis in Dermatology: Recognition and Management.

The incidence of syphilis has been increasing in the USA since 2000. Notably, the coronavirus disease 2019 pandemic negatively impacted the public health efforts to contain the spread of sexually transmitted diseases including syphilis and congenital syphilis. Clinical manifestations of syphilis are predominantly mucocutaneous lesions, thus dermatologists are primed to recognize the myriad presentations of this disease. Primary syphilis is classically characterized by a painless transient chancre most often located in the genital area. Secondary syphilis typically manifests clinically as systemic symptoms in addition to a mucocutaneous eruption of which a variety of forms exist. Although less common in the era of effective penicillin treatment, late clinical manifestations of syphilis are described as well. In addition to recognition of syphilis on physical examination, several diagnostic tools may be used to confirm infection. Treponema pallidum spirochetes may be detected directly using histopathologic staining, darkfield microscopy, direct fluorescent antibody, and polymerase chain reaction assays. A table detailing the histopathologic features of syphilis is included in this article. Serologic testing, non-treponemal and treponemal tests, is the preferred method for screening and diagnosing syphilis infections. Two serologic testing algorithms exist to aid clinicians in diagnosing positive syphilis infection. Determining the correct stage of syphilis infection combines results of serologic tests, patient history, and physical examination findings. Using the current Centers for Disease Control and Prevention case definitions and treatment guidelines, a management algorithm is proposed here. Penicillin remains the pharmacological treatment of choice although specific clinical situations allow for alternative therapies. Syphilis is a reportable disease in every state and should be reported by stage according to individual state requirements. Screening recommendations are largely based upon risks encountered through sexual exposures. Likewise, sexual partner management includes evaluating and treating persons exposed to someone diagnosed with an infective stage of syphilis. Close clinical follow-up and repeat testing are recommended to ensure appropriate response to treatment. This guide will discuss the current epidemiology of syphilis and focus on practice aspects of diagnosis and management, including public health reporting.

An Adolescent With Worsening Conjunctivitis, Stomatitis, and Odynophagia Consistent with a Postinfectious Mucocutaneous Eruption

An Adolescent With Worsening Conjunctivitis, Stomatitis, and Odynophagia Consistent with a Postinfectious Mucocutaneous Eruption

Histopathological Spectrum of Cutaneous Reactions following COVID-19 Vaccine - An Observational Study.

Owing to the myriad clinical presentations of COVID-19 vaccine-induced adverse events, clinicopathological correlation is the key to understanding the underlying pathophysiology of these reactions. However, there is still a dearth of such systematic studies across a wide spectrum of vaccine reactions. This study provides a clinical and histopathological correlation of COVID-19 vaccine-induced mucocutaneous reactions. The study population included all the individuals developing any form of self-reported mucocutaneous adverse events within 4 weeks of receiving the COVID-19 vaccine. The clinical and histopathological features were recorded. A total of 126 cases were identified. Seven histopathological patterns were recognized. The most common histopathological feature was spongiotic dermatitis, seen in all the patients with "vaccine-related eruption of papules and plaques" (VREPP). Other patterns included lichenoid or interface dermatitis, dermal hypersensitivity reaction, leukocytoclastic vasculitis, subepidermal blistering, psoriasiform hyperplasia, and dermal granulomatous reaction. Owing to such myriad clinical presentations, utilizing a histopathological classification could ease categorizing the vaccine-induced mucocutaneous eruptions.

Evolving mucocutaneous eruptions following chemotherapy

A 62-year-old male with follicular lymphoma presented with a 3-week history of worsening erythematous, coalescing papules and plaques with desquamative scale, and oral mucosa erosions starting 4 days after receiving rituximab, bendamustine, trimethoprim/sulfamethoxazole, and allopurinol (Fig 1, A-C). There was no improvement after holding medications, oral prednisone, and topical steroids. Biopsy of the dorsal hand was performed (Fig 2). Within 2 weeks, the rash progressed to erythroderma with erosions and hemorrhagic crusting of mucosal sites and diffusely on the body (Fig 3, A-C).