Acronym for Reactive Infectious Mucocutaneous Eruption.

Post-infectious mucocutaneous rash of immune origin (deposits of immune complexes) often associated with Mycoplasma pneumoniae pneumonia (found in 23 % of these pneumonias). Pathogenesis close to Stevens-Johnson syndrome but without any drug cause. Some cases have been associated with COVID 19. Onset: 7 to 10 days after an episode of cough with fever and arthralgia of:

• fever
• cough: chest X-ray - pulmonary infiltrates
• vesicobullous lesions (including on the palms of the hands and soles of the feet) on < 10 % of the body surface area, involving the skin, the oral (sometimes mucositis), anal (68 %) and urogenital mucous membranes (63 %). There is an ocular involvement (conjunctivitis) in 82 % of cases.

• Treatment: antibiotics, corticosteroids, sometimes IV gamma globulins.
• Risk of recurrence (6 %). Risk of death from pulmonary complications.

Anesthetic implications:

immunosuppression, pneumonia, fragile skin and mucous membranes

References : 

-        Ryder CY, Pedersen EA, Mancuso JB.
Reactive infectious mucocutaneous eruption secondary to SARS-CoV-2.
JAAD Case Reports 2021;18:103-5.

-        Tian J, Zhu T, Xiao Y.
A 6-year-old boy with cough, mucositis, and vesiculobullous skin lesions.
JAMA 2022 doi:10.1001/jama.2022.19628

Updated: December 2022