MIRM in an adolescent male: a diagnostic challenge and review of the literature

Mycoplasma-Induced Rash and Mucositis (MIRM) is a subset of Reactive Infectious Mucocutaneous Eruption (RIME), most commonly associated with Mycoplasma pneumoniae. MIRM commonly presents with significant mucositis and mild or absent cutaneous involvement. MIRM exists on a spectrum with Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Due to the significant clinical overlap, early diagnosis of MIRM can be challenging. We report a case of a 19-year-old male who presented with a two-day history of worsening throat pain and decreased oral intake after initiating Augmentin for treatment of community acquired pneumonia. During hospitalization, he developed progressive ocular, oral and genital lesions leading to a broad differential diagnosis including Behcet’s Disease, SJS and RIME/MIRM. Upon extensive evaluation, labs revealed elevated Mycoplasma pneumoniae IgM and IgG titers, supporting the diagnosis of MIRM. The patient was treated with high dose corticosteroids and had complete resolution of all symptoms. This case highlights the importance of early diagnosis, and involvement of a multidisciplinary team to help guide management.