Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Crowdsourcing Diagnosis and Treatment Strategies for Pediatric RIME Cases
Description
The session introduced a crowdsourced, audience-participation discussion of complex pediatric dermatology cases, focusing on reactive infectious mucocutaneous eruption (RIME) in children. The speakers emphasized that RIME is usually preceded by an infectious prodrome such as fever, cough, sore throat, and malaise, and presents with prominent mucosal involvement of the mouth, eyes, and sometimes genitals, with or without erythema multiforme-like skin lesions. For an 11-year-old with erosive mucositis and viral symptoms, the panel discussed initial workup options such as mycoplasma testing, respiratory viral panels, HSV testing, chest x-ray, and inflammatory labs, noting that mycoplasma is an important trigger but that respiratory panels may miss it, so separate PCR can be useful. They reviewed treatment approaches including empiric antimicrobials when an infectious trigger is suspected, systemic corticosteroids, cyclosporine, IVIG, and TNF-alpha inhibitors such as etanercept, with practice patterns shifting toward etanercept in some centers because of faster improvement, though some clinicians combine it with cyclosporine to reduce relapse. The evidence base was described as limited, consisting mostly of retrospective reviews and case series, with early therapy and supportive care being key. Supportive management includes admission, hydration, nutrition, pain control, oral hygiene, and multidisciplinary consultation with ophthalmology, ENT, gynecology/urology, and sometimes ICU involvement. The presenters concluded that outcomes are generally good, but reducing hospitalization and long-term complications is an important goal, and they encouraged collecting outcomes to better compare treatments.
View moreConclusions
- RIME is best understood as a mucosa-predominant, infection-triggered eruption in children that often follows a febrile respiratory prodrome and may have little or no skin involvement.
- The differential diagnosis for pediatric erosive mucositis is broad, but clinicians should strongly consider RIME when prodromal infectious symptoms and painful mucosal disease are present.
- Initial evaluation commonly targets infectious triggers such as Mycoplasma pneumoniae, HSV, influenza, COVID-19, and other respiratory pathogens, but testing practices vary.
- Mycoplasma testing appears to be the most consistently favored part of the initial workup, although no single test strategy is definitive.
- There is no strong evidence that identifying and treating the triggering infection alone changes the course of the mucocutaneous inflammation.
- Supportive care is a major part of management, including hydration, nutrition, pain control, oral care, and consultation with ophthalmology, ENT, and sometimes gynecology/urology.
- Systemic therapy is generally started early to try to shorten the inflammatory course and hospitalization.
- Although systemic corticosteroids remain commonly used, expert practice is shifting toward etanercept and other nonsteroid anti-inflammatory options in some centers.
- Etanercept is emerging as a favored first-line anti-inflammatory therapy because of rapid clinical improvement in reported cases and case series.
- Cyclosporine is also being used as a longer-acting adjunct or alternative in some patients, especially when relapse after initial response is a concern.
- The overall prognosis of RIME appears good, with very low mortality, but morbidity can be substantial because hospitalizations are often prolonged and complications such as ocular sequelae and strictures are possible.
- The field lacks robust comparative evidence, so documenting treatment choices and outcomes is important for building a better evidence base and improving future care.
- Kalyani Marathe, Robert J. Smith, Nessa Aghazadeh, Michelle Oboite, Sarah Coates, and Catherine Bridges. F005: Choose Your Own Adventure: Crowdsourcing for the Management of Complex and Refractory Pediatric Dermatology Cases. American Academy of Dermatology Annual Conference, Denver, Colorado, March 27, 2026.
- Kalyani Marathe, Robert J. Smith, Nessa Aghazadeh, Michelle Oboite, Sarah Coates, and Catherine Bridges. F005: Choose Your Own Adventure: Crowdsourcing for the Management of Complex and Refractory Pediatric Dermatology Cases. AAD Annual Meeting, March 7–11, 2025, Orlando, Florida.