Ocular manifestations of reactive infectious mucocutaneous eruption (RIME) secondary to adenovirus: A case report

Abstract

Purpose: To present an atypical case of reactive infectious mucocutaneous eruption (RIME) in an adult patient attributed to primary adenoviral infection.

Observations: This is a case describing the clinical course of a previously healthy 34-year old man who presented with acute onset urethritis and bilateral conjunctivitis. His left eye conjunctivitis progressed to pseudomembrane and symblepharon formation within days. His clinical course was marked by progressive worsening of urethritis and formation of mucus membrane ulceration and bullae even after antibiotic treatment and aggressive topical lubrication. He required admission and a multidisciplinary team made the diagnosis of adenovirus-induced RIME. He was treated with intravenous steroids and intravenous cyclosporine. He ultimately recovered with a good visual outcome.

Conclusions and importance: This case demonstrates a rare case of RIME in an adult triggered by an adenovirus infection. Multidisciplinary care is key to diagnosis and treatment.

Keywords: Adenovirus; Conjunctivitis; Reactive infectious mucocutaneous eruption (RIME).

Fig. 1

Composite external photo of the left eye in different positions of gaze on day 6. Note the extensive conjunctival injection and chemosis (white arrow) and mild mucoid discharge (yellow arrow). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

Representative photograph of beefy erosions on lower lip (white arrows) and lateral tongue oral ulcers (yellow arrows). Picture taken on day 12. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

Composite external photo of the left eye in different positions of gaze on day 9. Note the more exaggerated inflammatory response - subconjunctival hemorrhage, pseudomembranes - in the conjunctival fornices (white arrows) compared to the limbus (yellow arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

Composite external photo of the right eye in different positions of gaze on day 9 Note the more exaggerated inflammatory response (dilated conjunctival vessels, pseudomembranes, white arrows) in the conjunctival fornices compared to the limbus (yellow arrows). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)