Oral erythema multiforme em is considered as a third category of em other than em minor and major. 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. The diagnosis is based on the exclusion of other similar diseases. These lesions appear suddenly on the legs, arms, palms, hands, feet, and inside the mouth. 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. Erythema multiforme for parents nemours kidshealth. Erythema multiforme is an acute and a selflimiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. Erythema multiforme is caused by various insults often from an infectious agents, drugs and food additive 3,4,5. A the entire body was covered by welldefined erythematous patches with a targetoid shape.
Erythema multiforme em is an extremely rare condition in infancy. Erythema multiforme em is an acute mucocutaneous disease that characterized by being selflimiting and immunemediated. Oral blistering report of two cases of erythema multiforme. It presents a diagnostic dilemma because the oral cavity has the ability to produce varied manifestations. 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. Erythema multiforme em is an interesting dermatologic disease which has oral manifestations. The cutaneous lesions are pathognomonic because of their unique target. Erythema multiforme em is a hypersensitivity reaction characterized by varying degrees of blisters and ulcerations. Erythema multiforme causes, symptoms, treatment, pictures. Complete regression of the lesions with normal mucosa at the 1 month followup. Erythema multiforme minor, erythema multiforme major. Erythema multiforme is acute, inflammatory skin disease and has two clinical forms, minor and major. Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction characterized by skin eruptions with or without oral or other mucous membrane lesions.
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. Em is clinically characterized by a minor form and a major form. Multiple recurrence of oral erythema multiforme after secondary herpes simplex. Em typically affects young individuals mainly 2nd to 4th decades. Erythema multiforme em is one of the extremely rare, acute hypersensitivity reaction to various drugs including pyrazinamide. Herpes associated erythema multiformea diagnostic dilemma. 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. What information about erythema multiforme em should. It often also affects the mouth, eyes and other moist surfaces. An 11yearold boy had lesions in the oral cavity and lips, which had been diagnosed as erythema multiforme minor. Jul 16, 2009 the incidence of cutaneous adverse reactions to quinolones is low. Complete blood cell count was within normal limits, and no other. Apr 05, 2011 therefore, an otolaryngologist or a dentist while treating such patients should have a differential diagnosis for all oral lesions. In this report, we aimed to present a case of erythema multiforme major that necessitate symptomatic treatment.
Due to the similarities in clinical and histological findings, it was. 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. Case report recurrent erythema multiforme with arthritis a. Case report olgu sunusu oral lesions of drug induced erythema multiforme report of three cases ilac. 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 multiforme case history bmj best practice. An awareness of the varied patterns of cutaneous disease is essential for the early diagnosis and treatment of patients with manifestations of m. 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. In erythema multiforme minor, only one mucous membrane is affected and it usually is the oral mucosa. The incidence of cutaneous adverse reactions to quinolones is low. Here, we report a case of viralinduced em major where there are classical oral and dermal lesions in a 28yearold male patient. This causes significant distress to the patient, necessitating a thorough search for the underlying trigger. 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. A case of erythema multiforme with unknown etiology.
International journal of scientific study october 2014 vol 2 issue 7. Here, we report a case of viralinduced em major where there are. 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. It causes a rash of spots with dark centers and pale red rings that look like a target or bullseye. Therefore, an otolaryngologist or a dentist while treating such patients should have a differential diagnosis for all oral lesions.
Erythema multiforme em is an acute mucocutaneous hypersensitivity reaction characterised by a skin eruption, with or without oral or other mucous membrane lesions. Erythema multiforme can be induced by adverse drug reaction with a frequency of more than 1%. We report a case of recurrent herpesassociated erythema multiforme managed with prophylactic acyclovir. We report a case of a patient who was treated with. The rash is made of spots that are red welts, sometimes with purple or blistered areas in the center. It presents as a dermatological eruption featuring iris or target lesions, although other forms of skin lesion can occur hence the name. Erythema multiforme research papers on a skin condition from. Educate patients with erythema multiforme em about appropriate symptomatic treatment, and provide reassurance that disease is usually selflimited. Erythema multiforme nord national organization for rare.
The rash progressed rapidly over 2 days to involve most of her body, however, mucosal involvement was limited to her oral mucosa. Infections particularly herpes simplex and mycoplasma pneumonia and drugs seem to predispose toward the. Erythema multiforme em is a life threatening mucocutaneous disorder. Erythema multiform em is a rare disease in infancy. Adalimumab is a recombinant human igg1 monoclonal antibody specific for human tumor necrosis factor. Detailed case histories of five patients are presented to illustrate the role of azathioprine in treating oral lesions and to document a familial case of recurrent erythema multiforme, with severe. Authoritative facts about the skin from dermnet new zealand. Dietary supplement product composed of natural ingredients. Erythema multiforme is a skin condition that develops from an unknown cause. Erythema multiforme the journal of the american board of family. Erythema multiforme is an acute mucocutaneous disorder, characterized by varying degrees of blistering and ulceration. Erythema multiforme induced by alendronate sodium in a.
Erythema multiforme erythema multiforme research papers analyze a skin condition that develops from an unknown cause. Erythema multiforme secondary to herpes simplex infection. Erythema multiforme is a common skin disorder consisting of targetlike circular lesions. When a cause for erythema multiforme can be found, it should be treated, eliminated, or avoided e. 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 is associated with an acute onset and, usually, mild or no prodromal symptoms. An otherwise healthy, white, 10yearold boy complains of a sore throat. This report documents a patient who developed em secondary to a herpes simplex viral hsv infection. 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. Recurrent erythema multiforme after alcohol ingestion in a. In our case 1, the patient had a history of taking multidrugs and case 2 showed lesions due to food additives. Management of erythema multiforme associated with recurrent.
Possible implication of synergistic andor complementary immunomodulatory effects. Started in 1995, this collection now contains 6767 interlinked topic pages divided into a tree of 31 specialty books and 732 chapters. Erythema multiforme may be present within a wide spectrum of severity. We report a case of recurrent erythema multiforme em recalcitrant to previous therapy that showed complete response to adalimumab. Mucosal erosions as the presenting symptom in erythema. The lesion was selflimiting and abstinence from alcohol. 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. Pdf erythema multiforme em is a life threatening mucocutaneous disorder where. The cause is unknown, but em frequently occurs in association with herpes simplex virus, suggesting an immunologic process initiated by the virus. 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. Erythema multiforme can have association with a variety of diseases 4. Here we report a case of kd associated with erythema multiforme em as a variation from the expected. We report a case of erythema multiforme in which alcohol ethanol seems to be the. 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.
Oral erosions have limited his food and fluid intake. Erythema multiforme limited to the oral cavity report of a case irwin lighterman, d. Erythema multiforme em is an acute mucocutaneous condition. Erythema multiforme genetic and rare diseases information. Department of oral medicine faculty of dentistry universitas indonesia abstract erythema multiforme is polymorphous recurrent eruptions on the skin and oral mucosa. Erythema multiforme versus herpes simplex virus, what is the. We report a case of recurrent herpesassociated erythema multiforme in a 57 year old female patient managed with prophylactic acyclovir. Pdf minor erythema multiforme case report researchgate. Some spots can have a small blister or scab in the middle. 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. Diagnosis of kd is based on wellknown clinical criteria.
One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus. Discussion erythema multiforme is a type of reactive mucocutaneous disorder. Erythema multiforme induced by alendronate sodium in a geriatric patient. Although many suspected etiologic factors have been reported to cause em, em minor is regarded as being commonly triggered by hsv. We report a case of erythema multiforme in which alcohol. Recurrent oral erythema multiforme roem is now accepted as a lessrecognized subtype of erythema multiforme em. A case of erythema multiforme major developed after sequential use of two immune checkpoint inhibitors, nivolumab and ipilimumab, for advanced melanoma. 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. If it is mild, you may feel perfectly well, and your rash may be asymptomatic or associated with a mild itch or burning sensation. We report a case of a patient who was treated with systemic steroids for many years to control this. The lesions may complicate to lymphangitis or secondary bacterial infection, but systemic complications such as erythema multiforme, maculopapular rash, and generalized. 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. Erythema multiforme an overview sciencedirect topics.
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. Others allopurinol, acarbose, clofibrate, corticosteroids, hydralazine, mefloquine, methotrexate, minoxidil, nifedipine, oestrogen. Case report abstract erythema multiforme em is a mucocutaneous disorder, which ranges from a mild, selflimited, cutaneous, exanthematous. Dec 01, 2014 erythema multiforme em is a skin condition considered to be a hypersensitivity reaction to infections or drugs.
Erythema multiforme erythema multiforme em is an acute, self limiting, inflammatory skin eruption. 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. The symptoms will vary with the severity of the rash. This case details the diagnostic and management approach to erythema multiforme, a condition that warrants thorough consideration for the differential of stevensjohnson syndrome. We report a case of 19 years old female with pulmonary tuberculosis who developed biopsy proven em 45 days after initiation of att, as. 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. Two weeks following an eruption of herpes labialis, a 20. It occurs as erythema multiforme minor in 90% of the cases. The pdf file you selected should load here if your web browser has a pdf reader plugin installed. We present a case of 46yearold male who developed erythema multiforme after ingestion of alcohol, while being treated with ciprofloxacin. Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. Concentric colour zones are characteristic of target lesions, which vary in morphology hence the name erythema multiforme. Most people with classic erythema multiforme can be treated as outpatients with therapy, such as antihistamines, addressing their symptoms. The patient responded well to this treatment regimen and has been in remission to date.
Erythema multiforme adverse skin reactions to ssris are known to include rashes, erythema multiforme, stevenjohnson syndrome and toxic epidermal necrolysis 52 r, 53 r. Treatment of recurrent erythema multiforme with adalimumab. Systemic corticosteroid therapy is frequently used to treat this condition. Erythema multiforme em is a life threatening mucocutaneous disorder where early diagnosis and management is of utmost important. V erythema multiforme is a rather common inflammatory skin disorder, occurring most often on the face and hands. Here we report a rare association between em and polyarthritis in a male patient. Case report recurrent erythema multiforme with arthritis. Erythema multiforme em is an immunemediated disease with. Case report introduction recurrent erythema multiforme em is a disabling condition with a specific diagnosis and certain diagnostic criteria.
A case of recurrent erythema multiforme and its therapeutic. View enhanced pdf access article on wiley online library html. A comprehensive search of all pubmed case reports regarding em in young. Erythema multiforme has been so named because of the multiple forms it. Patients present with oral and lip ulcerations typical of em but without any skin target lesions. Red lesions have developed on his extremities, and he is having some difficulty breathing after exertion. C consensus, diseaseoriented evidence, usual practice, expert opinion, or case series. Oral prednisolone 30mg day was started along with topical triamcinolone acetonide 0. Complete regression of the lesions with normal mucosa at.
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