Paediatric and Adolescent Dermatology

Aims:To highlight an outbreak of reactive infectious mucocutaneous eruptions (RIME) secondary to Mycoplasma pneumoniae infections in Sydney, New South Wales; how to identify these cases and appropriately manage the affected patients.Methods: we performed a retrospective case series review of thirteen consecutive paediatric patients at the Sydney Children's Hospital, Randwick diagnosed with RIME between March and May 2024 by a paediatric dermatologist.The study was approved by the Sydney Children's Hospitals Network Human Research Ethics Committee (2024/ETH01030). Results:The mean age of the thirteen children (eight boys, five girls) was 11.7 years (range: 7-16 years); twelve were PCR positive for M. pneumoniae.The mean length of respiratory illness preceding the eruption was 7.4 days (range, 5-10 days).Oral manifestations were evident in all thirteen children, including haemorrhagic crusted lips, mucositis, and lip swelling.Seven children had cutaneous symptoms; eight had ocular conjunctivitis, and four had urethral lesions.All received supportive multidisciplinary care, including sodium bicarbonate mouthwash, lignocaine mouth rinse, paracetamol, ocular lubricants, soft white paraffin for their lips, a nasogastric tube for fluid and nutrition management, and pain team support.Six children received systemic immunosuppressants.The mean duration of hospitalisation was 7.4 (SD, 2.3) days; the mean length did not differ significantly between those who received immunosuppressants (8.2 [SD, 1.0] days) and those who did not (6.7 [SD, 0.8] days).The conditions of all thirteen children had improved within 14 days of admission, and they were discharged home.Conclusions: RIME can follow infections with M. pneumoniae or other respiratory pathogens in children and adolescents.It causes significant pain and distress for those affected and their families, but the prognosis is good, with expected recovery within 14 days.Supportive multidisciplinary treatment ensures the best outcomes.