Department of Dermatology, Geisinger Medical Center, Danville, Pennsylvania, USA.
J Cutan Pathol. 2023 Apr;50(4):321-325. doi: 10.1111/cup.14339. Epub 2022 Oct 18.
Reactive infectious mucocutaneous eruption (RIME) is a recently described entity in which there is prominent mucositis, most commonly involving the oral and urogenital mucosa, secondary to a variety of pathogens. There is typically minimal cutaneous involvement in RIME. This contrasts with erythema multiforme (EM) in which characteristic targetoid lesions predominate, usually in isolation (EM minor), but in a subset of cases, with severe mucositis (EM major). While the histopathologic features of RIME have not been as well defined, those of EM are characterized by epidermal apoptosis and interface dermatitis with lymphocytes making up the predominant cell type. We report a unique case of RIME in a 16-year-old male with COVID-19 characterized by significant mucositis involving the oral and genital mucosa, as well as numerous targetoid lesions on the trunk and extremities. Histopathologically, there was an inflammatory infiltrate obscuring and disrupting the epidermal interface, associated with epidermal necrosis, and blister formation. The infiltrate was composed of cells with irregular, non-segmented and elongate nuclei, with myeloid and histiocytoid cytomorphology. The cells were positive for myeloperoxidase, CD68, and CD163 (subset) suggesting myeloid lineage. RIME is a rarely reported COVID-19-related eruption, and targetoid lesions and myeloid interface reactions have not been described with RIME.
反应性感染性黏膜疹（RIME）是一种新近描述的疾病实体，其特征为多种病原体引起的显著黏膜炎，最常见于口腔和泌尿生殖道黏膜。RIME 通常仅有轻微的皮肤受累，这与以特征性靶形病变为主的多形性红斑（EM）不同，靶形病变通常孤立出现（EM 轻症），但在一部分病例中，同时伴有严重的黏膜炎（EM 重症）。虽然 RIME 的组织病理学特征尚未得到充分定义，但 EM 的特征是表皮凋亡和界面性皮炎，主要细胞类型为淋巴细胞。我们报告了一例 COVID-19 相关的 RIME 独特病例，该病例为 16 岁男性，表现为口腔和生殖器黏膜严重黏膜炎，以及躯干和四肢多处靶形病变。组织病理学检查显示，炎症浸润掩盖并破坏了表皮界面，伴有表皮坏死和水疱形成。浸润细胞具有不规则、不分叶和长形核，具有髓系和组织细胞样细胞形态。这些细胞对髓过氧化物酶、CD68 和 CD163（亚群）呈阳性，提示髓系来源。RIME 是一种罕见的与 COVID-19 相关的疹，尚未描述过靶形病变和髓系界面反应与 RIME 相关。
