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A novel mucocutaneous eruption was observed in an otherwise minimally symptomatic teenager with COVID-19, researchers found.

The 17-year-old boy presented to the emergency department with 3 days of mouth pain and "nonpainful penile erosions," and after extensive testing, was diagnosed with SARS-CoV-2-associated reactive infectious mucocutaneous eruption, reported Zachary Holcomb, MD, of Boston Children's Hospital, and colleagues.

Notably, the patient only experienced transient anosmia and ageusia, which resolved a week prior. He reported no fever, cough, dyspnea, rhinorrhea, or gastrointestinal symptoms, but tested positive for SARS-CoV-2 at the time, they wrote in .

"This case highlights what is, to our knowledge, the first report of SARS-CoV-2-induced RIME [reactive infectious mucocutaneous eruption] and distinguishes this entity from other mucocutaneous eruptions with substantially different prognoses and treatment algorithms," they added.

The patient's vital signs were normal, and a physical examination revealed "shallow erosions of the vermilion lips and hard palate, circumferential erythematous erosions of the periurethral glans penis, and 5 small vesicles on the trunk and upper extremities." Lab values were mostly normal, except for mild absolute lymphopenia and slightly elevated creatinine and C-reactive protein levels.

The patient tested positive for SARS-CoV-2 via nasopharyngeal PCR testing, but negative for Mycoplasma pneumoniae, adenovirus, Chlamydophila pneumoniae, human metapneumovirus, influenza A/B, parainfluenza 1 to 4, rhinovirus, and respiratory syncytial virus. M. pneumoniae IgG levels were elevated, but IgM plasma was negative. Therefore, the patient was diagnosed with SARS-CoV-2-associated reactive infectious mucocutaneous eruption.

After 3 days of worsening oral pain, the patient was prescribed 60 mg of oral prednisone once daily for 4 days, which improved his symptoms. Holcomb's group noted that the patient was initially prescribed betamethasone valerate 0.1% ointment for the lips and penis, intraoral dexamethasone solution, viscous lidocaine, and over-the-counter pain relief with acetaminophen or ibuprofen, if necessary.

Oral mucositis recurred 3 months later, and the patient was prescribed 80-mg oral prednisone daily for 6 days.

Holcomb and colleagues highlighted the difference between reactive infectious mucocutaneous eruption, with SARS-CoV-2 as the infectious trigger, and other skin eruptions. For example, "the sparse cutaneous involvement and lack of dusky targetoid lesions" distinguish it from Stevens-Johnson syndrome and erythema multiforme, which has been associated with SARS-CoV-2. It also differs from multi-system inflammatory syndrome in children (MIS-C), which is characterized by "mucocutaneous involvement, systemic symptoms, and dramatically elevated systemic inflammatory markers," they said.

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