Pneumonia and erythema multiforme exudativum: Report of four cases and three autopsies

Abstract

Four cases of erythema multiforme exudativum are reported; three of them were fatal and the autopsy findings are presented. There was a diffuse miliary type of pneumonia in two of the fatal cases and in the one with recovery. The pneumonia in these patients resembled that of the severe and diffuse type of primary atypical pneumonia of unknown etiology in every respect —clinically, roentgenographically and pathologically; it resembled that of psittacosis in many respects. In one of the fatal instances there was a significant amount of secondary bacterial infection. Evidence suggesting a possible infection with a psittacosis-like virus was obtained in three cases. In Case I there was a significantly high titer of antibody for psittacosis virus demonstrated by complement fixation. In Case II there was a significant rise in titer of such antibodies during the course of the illness and a history of contact with a dead pigeon eight days before the first symptom. In Case IV there was only a history of contact with a sparrow during its fatal illness. The latter patient died on the fifth day of his disease and the lungs showed only a few acute focal lesions in the alveolar walls. No virus was isolated from any of the patients. Cold agglutinins were demonstrated in high titer in the serum of the patient in Case I and appeared during the course of the illness in the patients in Cases II and III.