Abstract
Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. 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. Due to the similarities in clinical and histological findings, it was previously believed that erythema multiforme major was indistinguishable from Steven-Johnson syndrome (SJS). However, evidence suggests these are two distinct diseases with a different etiology. It is important for clinicians to readily identify the difference between erythema multiforme from SJS, as the prognosis and mortality rate vary significantly between the two disorders.
Highlights
Erythema multiforme has been associated with multiple etiologies, including medications, malignancies, and sarcoidosis, but about 90% of the cases can be attributed to infectious agents, more commonly herpes simplex virus in adults and mycoplasma pneumonia in children [1]
A herpes simplex virus infection can cause the release of IFN-gamma and the subsequent recruitment of CD4+ T helper cells, which may lead to epidermal tissue damage and the pathological findings associated with erythema multiforme [2]
It was thought that erythema multiforme belonged as a part of the Steven-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN) spectrum of diseases, most likely due to the similar clinical presentation of these disorders
Summary
Erythema multiforme has been associated with multiple etiologies, including medications, malignancies, and sarcoidosis, but about 90% of the cases can be attributed to infectious agents, more commonly herpes simplex virus in adults and mycoplasma pneumonia in children [1]. A 23-year-old Hispanic male presented to the emergency department, with rash, mouth sores, and subjective fevers that began after eating fish five days prior His symptoms started with sores in his mouth and on his lips with penile and anal pruritus. The patient reported having unprotected intercourse with a female two months ago He denied ever having anal intercourse, a history of sexually transmitted infections, dysuria, or penile discharge. He had heme-crusted polycyclic erosions of vermillion lips, buccal mucosa, and labial mucosa (Figure 1) He was found to have numerous 2-12 mm erythematous, urticarial, targetoid papules and plaques with central hyperpigmented purple/red duskiness over bilateral palms (Figure 2, Figure 3), dorsal hands, upper arms, lateral neck (Figure 4), cheeks, nasal tip, and alae. On the day of discharge, the patient’s rash and sores were improving and he did not have any new lesions
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