Herpes iris erythema multiforme manifested after human herpes virus type 1 (HHV-1) labial infection

Abstract

Erythema multiforme (EM) is an acute, self-limiting, often recurrent disease, with or without mucosal involvement, which occurs in an IV type hypersensitivity reaction provoked by infectious, medication, physical, chemical, etc. agents. In erythema multiforme related to the human virus type 1 (HHV-1) infection, the skin and mucosal manifestations are a result from a cell-mediated immune response, directed against HSV-DNA polymerase-positive antigen cells (keratinocytes). We present a clinical case of a 33-year-old female patient with recurrent labial followed by a clinical appearance of EM. About a week after the resolution the recurrence, burning and itchy erythematous target lesions and blisters occurred involving upper and lower limbs, then spread to the face, neck, neckline, typical for EM. In some of the target lesions, a central blister appeared, surrounded by vesicles - iris of EM type. Serology tests established high positive antibodies to HSV-1 of IgG type (154 UI/mL). Based on the characteristic clinical findings we diagnosed iris erythema multiforme, related to HHV1 infection. The presented case is an interesting manifestation of the morphological type of EM, described by Thomas Bateman in 1817, herpes iris, preceded by a relapse of the infection.