Some spots can have a small blister or scab in the middle. Erythema multiforme minor, erythema multiforme major, stevensjohnson syndrome definition. The lesions may complicate to lymphangitis or secondary bacterial infection, but systemic complications such as erythema multiforme, maculopapular rash, and generalized. Case report abstract erythema multiforme em is a mucocutaneous disorder, which ranges from a mild, selflimited, cutaneous, exanthematous. Others allopurinol, acarbose, clofibrate, corticosteroids, hydralazine, mefloquine, methotrexate, minoxidil, nifedipine, oestrogen. Oral erythema multiforme em is considered as a third category of em other than em minor and major. Case report recurrent erythema multiforme with arthritis. View enhanced pdf access article on wiley online library html. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name.
Discussion erythema multiforme is a type of reactive mucocutaneous disorder. C consensus, diseaseoriented evidence, usual practice, expert opinion, or case series. Concentric colour zones are characteristic of target lesions, which vary in morphology hence the name erythema multiforme. Although many suspected etiologic factors have been reported to cause em, em minor is regarded as being commonly triggered by hsv. Here we report a rare association between em and polyarthritis in a male patient. Oral prednisolone 30mg day was started along with topical triamcinolone acetonide 0. Two weeks following an eruption of herpes labialis, a 20.
Papules, scales, plaques and eruptions picture of erythema multiforme 2 erythema multiforme tends to be acral in distribution, and the dorsum of the hand is a particularly common location. A case of erythema multiforme was described in a 9yearold boy following treatment with sertraline. Erythema multiforme limited to the oral cavity report of a case irwin lighterman, d. Erythema multiforme induced by alendronate sodium in a geriatric patient. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. Erythema multiforme em is an immunemediated disease with. A comprehensive search of all pubmed case reports regarding em in young. Dec 01, 2006 erythema multiforme usually occurs in adults 20 to 40 years of age,6 although it can occur in patients of all ages. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme minor.
Diagnosis of kd is based on wellknown clinical criteria. It can present as either a mild rash or a severe, life threatening form known as erythema multiforme major. We present a case of 46yearold male who developed erythema multiforme after ingestion of alcohol, while being treated with ciprofloxacin. Erythema multiforme genetic and rare diseases information. Erythema multiforme is a skin condition that develops from an unknown cause. It occurs as erythema multiforme minor in 90% of the cases. Systemic corticosteroid therapy is frequently used to treat this condition. The pdf file you selected should load here if your web browser has a pdf reader plugin installed.
Erythema multiforme can have association with a variety of diseases 4. The patient responded well to this treatment regimen and has been in remission to date. Erythema multiforme secondary to herpes simplex infection. Erythema multiforme research papers on a skin condition from. Erythema multiforme nord national organization for rare. A case of erythema exudativum multiforme idiopathic form treatment problems asya krasteva, evgeniy aleksiev, tzveteliva gocheva, angelina kisselova department of imaging and oral diagnostic, faculty of dental medicine, medical university of sofia, bulgaria journal of imab annual proceeding scientific papers vol. A case of erythema multiforme major developed after sequential use of two immune checkpoint inhibitors, nivolumab and ipilimumab, for advanced melanoma. Case report introduction recurrent erythema multiforme em is a disabling condition with a specific diagnosis and certain diagnostic criteria.
Case report abstract erythema multiforme em is a mucocutaneous disorder, which ranges from a mild, selflimited, cutaneous, exanthematous variant with minimal oral involvement to a progressive, fulminating, severe variant with extensive mucocutaneous epithelial necrosis stevensjohnson syndrome sjs. A case of recurrent erythema multiforme and its therapeutic. In our case 1, the patient had a history of taking multidrugs and case 2 showed lesions due to food additives. We report a case of recurrent erythema multiforme em recalcitrant to previous therapy that showed complete response to adalimumab. In erythema multiforme minor, only one mucous membrane is affected and it usually is the oral mucosa. Pdf minor erythema multiforme case report researchgate. This case details the diagnostic and management approach to erythema multiforme, a condition that warrants thorough consideration for the differential of stevensjohnson syndrome. Treatment of recurrent erythema multiforme with adalimumab. Erythema multiforme for parents nemours kidshealth. We report a case of a patient who was treated with systemic steroids for many years to control this. Oral erosions have limited his food and fluid intake.
Infections particularly herpes simplex and mycoplasma pneumonia and drugs seem to predispose toward the. Erythema multiforme adverse skin reactions to ssris are known to include rashes, erythema multiforme, stevenjohnson syndrome and toxic epidermal necrolysis 52 r, 53 r. Erythema multiforme can be induced by adverse drug reaction with a frequency of more than 1%. An awareness of the varied patterns of cutaneous disease is essential for the early diagnosis and treatment of patients with manifestations of m. It often also affects the mouth, eyes and other moist surfaces. This report documents a patient who developed em secondary to a herpes simplex viral hsv infection. We report a case of recurrent herpesassociated erythema multiforme in a 57 year old female patient managed with prophylactic acyclovir. Red lesions have developed on his extremities, and he is having some difficulty breathing after exertion. This case is describing a progression of a case of erythema multiforme in oral mucosa of a 33 year old man suggesting of herpes viral involvement. Here, we report a case of viralinduced em major where there are classical oral and dermal lesions in a 28yearold male patient. Possible implication of synergistic andor complementary immunomodulatory effects.
A case report of erythema multiforme ramlal gantala, 1 rama raju devaraju, 2 srikanth goud g, 3 harisha aitha, 4 and jitender reddy kubbi 5 1 associate professor, department of oral medicine and radiology, svs institute of dental sciences, appanapally, mahabubnagar, telangana, india. We report a case of 4 y old girl child born for noncustodial parents who has a history of seizures and a known case of carbamazepineinduced sle systemic lupus erythematosus when treated with antiinflammatory drugs developed em. A the entire body was covered by welldefined erythematous patches with a targetoid shape. Erythema multiforme em is an acute mucocutaneous condition. Erythema multiforme causes, symptoms, treatment, pictures. Educate patients with erythema multiforme em about appropriate symptomatic treatment, and provide reassurance that disease is usually selflimited. Erythema multiforme em is a skin condition characterized by hyperreaction of very sensitive skin to primarily an underlying case of herpes simplex viral infection which results in the formation of abnormal skin lesions. Marshall webster, dds doctors webster is in the department of pedodontics, university of nebraska college of dentistry, lincoln, 68503. We report a case of 19 years old female with pulmonary tuberculosis who developed biopsy proven em 45 days after initiation of att, as. Management of erythema multiforme associated with recurrent. The rash progressed rapidly over 2 days to involve most of her body, however, mucosal involvement was limited to her oral mucosa. Erythema multiforme is a common skin disorder consisting of targetlike circular lesions.
Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Erythema multiforme erythema multiforme em is an acute, self limiting, inflammatory skin eruption. To the best of our knowledge, there have been only three cases of neonatal em described in the literature, and no such cases have been reported in korea. The cutaneous lesions are pathognomonic because of their unique target. Here, we report a case of viralinduced em major where there are. Dietary supplement product composed of natural ingredients. An otherwise healthy, white, 10yearold boy complains of a sore throat. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. The rash is made of spots that are red welts, sometimes with purple or blistered areas in the center. Erythema multiforme versus herpes simplex virus, what is the. Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction characterised by a skin eruption, with or without oral or other mucous membrane lesions. We report a case of a patient who was treated with.
Em is clinically characterized by a minor form and a major form. Stevensjohnson syndrome at one time considered to be a separate disease mucocutaneousocular disease now recognized as simply a very severe bullous form of em with widespread involvement typically including the skin, oral cavity, eyes and genitalia. Here we report a case of kd associated with erythema multiforme em as a variation from the expected. Erythema multiforme is an acute and a selflimiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. Recurrent oral erythema multiforme roem is now accepted as a lessrecognized subtype of erythema multiforme em.
There are two variants of this condition, one with mucosal involvement, termed erythema multiforme major, and one without mucosal involvement, known as erythema multiforme minor. A case of erythema multiforme with unknown etiology. Jul 16, 2009 the incidence of cutaneous adverse reactions to quinolones is low. When a cause for erythema multiforme can be found, it should be treated, eliminated, or avoided e. Erythema multiforme em is an acute mucocutaneous disease that characterized by being selflimiting and immunemediated. Erythema multiforme em is a hypersensitivity reaction characterized by varying degrees of blisters and ulcerations. Authoritative facts about the skin from dermnet new zealand.
Most people with classic erythema multiforme can be treated as outpatients with therapy, such as antihistamines, addressing their symptoms. This causes significant distress to the patient, necessitating a thorough search for the underlying trigger. Case report recurrent erythema multiforme with arthritis a. Erythema multiforme is caused by various insults often from an infectious agents, drugs and food additive 3,4,5. Erythema multiforme erythema multiforme research papers analyze a skin condition that develops from an unknown cause. Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction characterized by skin eruptions with or without oral or other mucous membrane lesions. Mucosal erosions as the presenting symptom in erythema. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs. Erythema multiforme is associated with an acute onset and, usually, mild or no prodromal symptoms.
Pdf erythema multiforme em is a life threatening mucocutaneous disorder where. Recurrent erythema multiforme after alcohol ingestion in a. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. Here we report a case of herpesinduced recurrent erythema multiforme primarily manifesting in oral mucosa during first two episodes and third episode was characterized by oral lesions followed by. International journal of scientific study october 2014 vol 2 issue 7. Apr 05, 2011 therefore, an otolaryngologist or a dentist while treating such patients should have a differential diagnosis for all oral lesions. Among various etiological agents, viral etiology is the most common and is characterized by ulcerations, erosions, and bleeding within the mucosa associated with encrustations and tissue tags. Erythema multiforme em is a life threatening mucocutaneous disorder where early diagnosis and management is of utmost important.
Erythema multiforme em is an extremely rare condition in infancy. Nov 14, 2011 erythema multiforme em refers to a group of hypersensitivity disorders characterized by symmetric red, patchy lesions, primarily on the arms and legs. The symptoms will vary with the severity of the rash. Erythema multiforme introduction and epidemiology erythema multiforme em is an acute, immunemediated condition, most commonly induced by herpes simplex virus hsv infection, or by the use of medications, such as phenytoin, sulfonamides, penicillins, and barbiturates. Erythema multiforme may be present within a wide spectrum of severity. Nov 23, 2012 we report the case of a patient with sequentially appearing skin manifestations, including erythema nodosum, erythema multiforme and henochschonlein purpura associated with m. Erythema multiforme em is one of the extremely rare, acute hypersensitivity reaction to various drugs including pyrazinamide. We report a case of erythema multiforme in which alcohol. Complete blood cell count was within normal limits, and no other. Multiple recurrence of oral erythema multiforme after secondary herpes simplex. Case report multidruginduced erythema multiforme sr isik,1 g karakaya,1 g erkin,2 af kalyoncu,1 1department of chest diseases, adult allergy unit, hacettepe university school of medicine, sihhiye, ankara, turkey 2department of dermatology, hacettepe university school of medicine, sihhiye, ankara, turkey abstract. Patients present with oral and lip ulcerations typical of em but without any skin target lesions.
Due to the similarities in clinical and histological findings, it was. Erythema multiforme minor, erythema multiforme major. V erythema multiforme is a rather common inflammatory skin disorder, occurring most often on the face and hands. In this report, we aimed to present a case of erythema multiforme major that necessitate symptomatic treatment. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. We report a case of erythema multiforme in which alcohol ethanol seems to be the.
One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus. Erythema multiforme induced by alendronate sodium in a. Case report a 96yearold woman was referred by her geriatrician to the oral medicine clinic, school of dentistry, federal university of minas gerais ufmg, for evaluation of. Erythema multiform em is a rare disease in infancy. Em typically affects young individuals mainly 2nd to 4th decades. Erythema multiforme an overview sciencedirect topics. Erythema multiforme case history bmj best practice. Therefore, an otolaryngologist or a dentist while treating such patients should have a differential diagnosis for all oral lesions. Erythema multiforme the journal of the american board of family. Erythema multiforme has been so named because of the multiple forms it. It presents a diagnostic dilemma because the oral cavity has the ability to produce varied manifestations. The lesion was selflimiting and abstinence from alcohol.
Case report olgu sunusu oral lesions of drug induced erythema multiforme report of three cases ilac. Case report herpes associated erythema multiforme a diagnostic dilemma mallika kishore1, sunil r panat2, ashish aggarwal3, nitin upadhyay4, nupur agarwal 5 1 post graduate student, department of oral medicine and radiology, institute of dental sciences, bareilly u. Recently, erythema multiforme has been classified as minor, major, stevensjohnson syndrome or toxic epidermal necrolysis, where erythema multiforme minor is the mildest type of lesion and toxic epidermal necrolysis the most severe2,3 table 1. Em is clinically diagnosed by the presence of these typical target lesions, as well as raised atypical targets, which most often erupt acrally in em as was the case in this patient. The diagnosis is based on the exclusion of other similar diseases. What information about erythema multiforme em should. Complete regression of the lesions with normal mucosa at the 1 month followup. Erythema multiforme em is an interesting dermatologic disease which has oral manifestations. If it is mild, you may feel perfectly well, and your rash may be asymptomatic or associated with a mild itch or burning sensation.
Oral blistering report of two cases of erythema multiforme. Complete regression of the lesions with normal mucosa at. Adalimumab is a recombinant human igg1 monoclonal antibody specific for human tumor necrosis factor. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth. Department of oral medicine faculty of dentistry universitas indonesia abstract erythema multiforme is polymorphous recurrent eruptions on the skin and oral mucosa. Erythema multiforme em is a life threatening mucocutaneous disorder. Erythema multiforme is acute, inflammatory skin disease and has two clinical forms, minor and major.
Feb 20, 2020 erythema multiforme em is an acute, selflimited, and sometimes recurring skin condition that is considered to be a type iv hypersensitivity reaction associated with certain infections, medications, and other various triggers. Sequentially appearing erythema nodosum, erythema multiforme. The incidence of cutaneous adverse reactions to quinolones is low. Herpes associated erythema multiformea diagnostic dilemma.
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