Erythema Multiforme-like Eruption Research Articles

CD04 An unusual case of menorrhagia and an episodic rash

Abstract A 24-year-old female university student from Hong Kong was referred with a 4-month history of a vesicular rash on her lips, eyes and oral mucosa that always appeared around the same time of her menstrual cycle. She would also get similar lesions on her neck, arms and legs. She was seen in dermatology and given a provisional diagnosis of erythema multiforme/recurrent herpes simplex and started on treatment, as well as prophylactic dose aciclovir for a few months. Despite this, there was no improvement in symptoms and her viral swabs also came back negative. She was referred for a second opinion, and, on reviewing her history, she volunteered that she suffers from menorrhagia. On questioning regarding any use of painkillers, she took out a packet of 60-mg etoricoxib that she had been getting from Hong Kong over the counter (OTC) and which was not on her records in the UK. She was taking this on day 1 of her period, and the vesicular eruption appeared the following day; it also became apparent that it would occur at the same sites on her body each time. A fixed drug eruption (FDE) to etoricoxib was suspected, and patch testing was undertaken to our baseline, facial and photopatch series (which includes a number of nonsteroidal anti-inflammatory drugs), to the medication crushed in paraffin applied to the back as standard and also to the specific sites at which the eruptions occur on the neck, arms and legs (lesional skin) under occlusion. No reactions were seen at 48 h, but at 72 h, we noted vesicular eruptions morphologically identical to the very dramatic photos she had on her phone but only in the areas where she had previously reacted (lesional skin); no reaction was seen on the nonlesional skin on the back where the standard patch testing was performed. Her rash fully resolved after stopping the etoricoxib. This case highlights the importance of enquiring about OTC medications when seeing patients with unusual or recalcitrant presentations as the flare with the menstrual cycle was a red herring and also highlights the importance of patch testing lesional skin with the culprit medication to avoid false negatives when considering FDE. This is a rare presentation of a FDE to etoricoxib, with only eight other cases reported in the literature, but this should be considered as a differential diagnosis in someone presenting with an erythema multiforme-like eruption.

A Case of Japanese Spotted Fever Showing Erythema Multiforme-like Eruption in Which Next-generation Sequencing Analysis was Useful for the Diagnosis

A Case of Japanese Spotted Fever Showing Erythema Multiforme-like Eruption in Which Next-generation Sequencing Analysis was Useful for the Diagnosis

Skin rash associated with combined cytotoxic chemotherapy and immunotherapy for cancer: A retrospective single-center case series.

In recent years, the development of combination therapies with immune checkpoint inhibitors (ICIs) and cytotoxic anticancer drugs has radically changed the management of diverse malignancies and significantly improved patient outcomes. Several clinical trials have shown that skin rash caused by combination therapy with ICIs and cytotoxic drugs may be more frequent and severe than that developing after administration of ICIs alone or cytotoxic drug monotherapy. However, most reports provide little information on severity, treatment, post-diagnosis course, and recurrence of rashes on drug rechallenges. We aimed to describe the experience of skin rashes developing within 2 weeks from the first administration of combination therapy with ICIs and cytotoxic drugs in 11 patients visiting our dermatology department. This study included seven men and four women, and the patients' median age was 52 years. The primary disease was non-small-cell lung cancer in eight patients, cervical cancer in two patients, and esophageal cancer in one patient. Nine patients had a maculopapular rash and two patients developed erythema multiforme-like eruptions. The skin rash was often accompanied by extracutaneous symptoms, such as fever (n=9), mucositis (n=4), and liver dysfunction (n=2). In all cases, the symptoms improved with topical steroid therapy alone, with no patients exhibiting severe symptoms requiring systemic steroids or immunosuppressive agents. In addition, when the causative drugs were re-administered after recovery from the rash, only two patients relapsed with accompanying systemic symptoms, and all patients except one were able to continue treatment using the same drug regimen. Although it was suggested that the rash caused by the combination therapy of ICIs and cytotoxic drugs may be more prominent than that caused by each agent alone, comprehensive judgment, including histopathological examination, may indicate the feasibility of continuing the treatment regimen for cancer.

Cutaneous adverse events related to COVID-19 vaccines: A cross-sectional questionnaire-based study of 867 patients.

Considering the emergency approval of the Food and Drug Administration for widespread use of coronavirus disease 2019 (COVID-19) vaccines, evaluating potential vaccine-related adverse effects is critical as it will allow physicians to diagnose and manage these complications properly. In this descriptive cross-sectional questionnaire-based study, we evaluated the possible side effects of the COVID-19 vaccine from June 1, 2021 to June 21, 2021. The Iranian population is generally vaccinated with AstraZeneca, Sputnik V, Sinopharm, and Bharat vaccines. The continuous and categorical variables were described and data analyzed by the SPSS software version 25. Cutaneous reactions occurred in 30% of individuals vaccinated against COVID-19. The most common cutaneous complications were focal injection site reaction, exanthematous rash, and urticaria. There were infrequent cutaneous adverse events that included vesicular eruption, pernio-like lesions, angioedema, erythema multiforme-like eruption, and zoster. Acquainting physicians with COVID-19 vaccine-related cutaneous complications will assist them in detection and management. In addition, introducing these complications to individuals might improve acceptance of vaccine-related adverse effects in the general population.

Nondrug-related erythema multiforme-like eruption in a mild case of COVID-19

The diagnostic and prognostic significance of cutaneous affection in COVID-19 remains unclear. Some of the reported skin manifestations including erythema multiforme were considered associated cutaneous adverse drug reactions. Furthermore, it was suggested that erythema multiforme can be associated with good prognosis for COVID-19 infection. This case report, likewise, describes a patient with mild symptoms of COVID-19, presenting with localized erythema multiforme-like lesions of the palms. The skin lesions appeared before receiving any medications. This supports that erythema multiforme can be a cutaneous presentation of COVID-19, rather than a drug eruption.

Cutaneous Manifestations of COVID-19: An Evidence-Based Review

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has affected 18 million people and killed over 690,000 patients. Although this virus primarily causes respiratory symptoms, an increasing number of cutaneous manifestations associated with this disease have been reported.ObjectiveThe aim of this review was to collate and categorize the dermatologic findings reported in patients with COVID-19 and identify specific lesions that may facilitate diagnosis and prognostication.MethodsAn evidence-based review of the PubMed database was conducted on 14 May, 2020 using the search terms “Covid-19 skin,” “Covid-19 rash,” “Covid-19 exanthem,” and “Covid-19 chilblains.” Peer-reviewed publications containing original COVID-19 patient cases and a discussion of the associated cutaneous findings were included in the analysis.ResultsThe literature search identified 115 records, of which 34 publications describing 996 patients with dermatologic conditions were included. Case reports (n = 15), case series (n = 13), and observational prospective studies (n = 4) were the most common publication types. Acral lesions resembling pseudo-chilblains were the most frequent lesion identified (40.4% of cases), appearing in young adults (mean age, 23.2 years) after the onset of extracutaneous COVID-19 symptoms (55/100 patients). Erythematous maculopapular rashes affected 21.3% of patients, most frequently impacting middle-aged adults (mean age, 53.2 years) and occurring at the same time as non-cutaneous symptoms (110/187 patients). Vesicular rashes affected 13.0% of patients, appearing in middle-aged adults (mean age, 48.3 years) after the onset of other symptoms (52/84 patients). Urticarial rashes affected 10.9% of patients, appearing in adults (mean age, 38.3 years) and occurring at the same time as non-cutaneous symptoms (46/78 patients). Vascular rashes resembling livedo or purpura were uncommon (4% of cases), appearing in elderly patients (mean age, 77.5 years) and occurring at the same time as non-cutaneous COVID-19 symptoms (18/29 patients). Erythema multiforme-like eruptions, although infrequent (3.7% of cases), affected mostly children (mean age, 12.2 years).ConclusionsVesicular rashes may suggest an initial diagnosis of COVID-19, acral lesions may be most appropriate for epidemiological uses, and vascular rashes may be a useful prognostic marker for severe disease. As a potential correlate to disease severity, prognosis, or infectibility, it is critical that all healthcare professionals be well versed in these increasingly common cutaneous manifestations of COVID-19.

Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): A prospective study from China and Italy

Cutaneous manifestations related to coronavirus disease 2019 (COVID-19): A prospective study from China and Italy

Karboksyterapia w świetle najnowszych doniesień. Zmiany skórne typu rumienia wielopostaciowego indukowane wirusem opryszczki jako powikłanie zabiegu karboksyterapii

Karboksyterapia w świetle najnowszych doniesień. Zmiany skórne typu rumienia wielopostaciowego indukowane wirusem opryszczki jako powikłanie zabiegu karboksyterapii

Hemophagocytic lymphohistiocytosis presenting with annular erythema multiforme-like eruptions in a patient with angioimmunoblastic T cell lymphoma: A case report.

Angioimmunoblastic T cell lymphoma (AITL)-associated hemophagocytic lymphohistiocytosis (HLH) rarely occurs with annular erythema multiforme-like rashes. The present case report describes a patient who was misdiagnosed with erythema multiforme at an early stage of the disease due to annular erythema multiforme-like eruptions. However, antihistamine treatment was ineffective. The patient progressed rapidly with high fever, hepatosplenomegaly and pharyngitis. The number of copies of Epstein-Barr virus DNA continuously increased. Accompanied by the swelling of lymph nodes, the blood cell count decreased. Further bone-marrow examination and biopsy of the lymph nodes were conducted. The patient was eventually diagnosed with AITL-associated HLH, and treated with etoposide together with cyclophosphamide, doxorubicin, vincristine and prednisolone. The patient was successfully treated with several courses of chemotherapy. In view of the fact that AITL-associated HLH with annular erythema multiforme-like rashes is relatively rare worldwide and is associated with a high mortality rate, the data on previous cases were reviewed with the hope of providing clinical bases for early diagnosis and treatment of AITL-associated HLH.

Novel interferon-γ enzyme-linked immunoSpot assay using activated cells for identifying hypersensitivity-inducing drug culprits

BackgroundThe drug-induced lymphocyte stimulation test (DLST), also referred to as lymphocyte transformation test (LTT), is used to identify the culprit drug in cases of cutaneous adverse drug reactions (cADR). Although DLST is a widely used in vitro test, its sensitivity and specificity are unsatisfactory. Recent reports suggest that the detection of drug-induced interferon (IFN)-γ production using enzyme-linked immunoSpot (ELISpot) assay (conventional IFN-γ ELISpot) is useful for identifying culprit drugs in cADR cases. ObjectiveThe aim of this study was to establish a novel method for identifying culprit drugs in patients with cADR by efficiently detecting drug-specific IFN-γ production using activated cells. MethodsSixteen patients with cADR, including drug-induced hypersensitivity syndrome, erythema multiforme-like eruption, maculopapular exanthema, Stevens-Johnson syndrome, and toxic epidermal necrolysis, caused by clinically convincing culprit drugs were enrolled in this study. In some cases, the blood samples were obtained at two or three different time points. Peripheral blood mononuclear cells (PBMCs) from total 20 samples were analyzed using both the DLST and drug-induced conventional IFN-γ ELISpot. In addition, drug-induced IFN-γ ELISpot was performed using PBMCs, which were stimulated with anti-cluster of differentiation (CD)-3/CD28 antibody-coated microbeads and interleukin (IL)-2 for 7 days before exposure to the culprit drugs (modified IFN-γ ELISpot). ResultsAmong the culprit drugs tested in each patient, the modified IFN-γ ELISpot was positive in 17 samples (13 patients) while DLST and conventional IFN-γ ELISpot were positive in eight and four samples (six and three patients), respectively. ConclusionThe modified IFN-γ ELISpot using activated PBMCs was more sensitive than the conventional IFN-γ ELISpot was for detecting drug-induced IFN-γ production, which could be a useful in vitro tool for identifying culprit drugs in cADR cases.

Complete Kawasaki Disease in a 21-Year-Old Caucasian Patient

Kawasaki disease is a rare condition in adults and it may remain unrecognized because many pa-tients do not fulfil all the diagnostic criteria for the diagnosis of “complete” Kawasaki disease. The authors report a case of 21-year-old male Caucasian patient complaining fever and presenting a diffuse maculopapular and erythema multiforme-like eruption, erythema and edema of the hands, feet and ears, non-exudative bilateral conjunctivitis, injected lips, strawberry tongue and symmetrical widespread lymphadenopathy. On the basis of clinical presentation, laboratory results and diagnostic criteria, a diagnosis of complete Kawasaki disease has been done. After treatment with systemic corticosteroids and aspirin (100 mg trice daily), the patient showed clinical improvement with typical large scale desquamation of the hands. The patient did not present any complication during one month follow-up. It is important to be familiar with the signs and symptoms of Kawasaki disease, because early diagnosis and adequate treatment is crucial for the prevention of cardiovascular morbidity and mortality.

Erythema multiforme-like eruption following allergic contact dermatitis in response to para-phenylenediamine in a temporary henna tattoo

Erythema multiforme-like eruption following allergic contact dermatitis in response to para-phenylenediamine in a temporary henna tattoo

Cannabis-induced erythema multiforme-like recurrent drug eruption

Cannabis-induced erythema multiforme-like recurrent drug eruption

393 Redness of Skin

BackgroundInfections are caused by staphylococcus bacteria commonly found on the skin or mucosal membranes of healthy patients. These bacterias can turn into blood stream and cause severe life-threatining conditions: severe erythema multiforme-like eruption of skin and lesions of the oral, genital and anal mucosa associated with fever, arthralgia and neurological symptoms. To find the correct diagnosis among mucocutaneous diseases sometimes difficult but is important for choosing the proper medication.MethodsA 10 month old boy with symptoms starting 2 days before with upper airway tract infection, external otitis and some urticarial eruption on his body without fever. He was put on oral antihistamin and antibiotic treatment. He was reffered to our Department because of high fever, conjunctivitis, stomatitis and redness of his skin all over his body with some blister formation. He was unable to eat, he was in pain, but sleepy. After a few hours of his admission his fever became 39°C, severe exfoliation occured, and some large flaccid bullaes appeared and erupted, drained an amber-colored liquid and spreaded to cover extensive areas of his body revealing denuded skin. His history and symptoms suggested allergic reaction for his medication or autoimmun/ mucocutaneous disorder, but interestingly his laboratory tests were in the normal range. In spite of these to prevent a bacterial superinfection after bacterial culturing of throat, nose, skin, and blood, we introduced iv amoxicillin/clavulanic-acid therapy, cyclesonide eye drops, antiseptic local treatment of mouth (chlorhexidine digluconate) and skin (unguentum antisepticum). After 2 days his fever stopped and the top layer of his skin started to come off, partly powdery scales formed.ResultsThe symptoms started to resolve slowly and the child became symptome free after 10 days. Bacterial culturing results confirmed the diagnosis of SSSS. The antibiotic treatment was completed on the tenth day.ConclusionsSymptomes and appearence of the disease suggested several diseases but the laboratory tests were normal, making the diagnosis more difficult, the supposed diagnosis did not fit properly for the patient age. Careful observation of patients and the disease, exfoliative cytology and a biopsy, microbiological investigations allow the diagnosis, ruling out erythema multiforme and drug-induced toxic epidermal necrolysis, both which are similar to SSS Syndrome.

Allergic Contact Dermatitis Syndrome Due to Tocopherol Acetate, in Addition to Glycyrrhetinic Acid

Natural vitamin E is suggested to have an antioxidant function. However, the synthetic form of vitamin E, DL-tocopherol, which has been widely used in topical ointments, may cause allergic contact dermatitis. Here, we report a case of allergic contact dermatitis with erythema multiforme-like eruption caused by a topical ointment. Patch testing indicated a positive allergic reaction to an anti-inflammatory ointment the patient had been using and its ingredient, DL-alpha-tocopheryl acetate (vitamin E). In addition, a positive reaction to glycyrrhetinic acid was observed. Both vitamin E and glycyrrhetinic acid are useful ingredients of topical applications. However, the possibility that both can cause contact dermatitis, albeit rarely, should be considered.

Two cases of pustular toxic epidermal necrolysis

Toxic epidermal necrolysis (TEN) is a life-threatening, immune-mediated reaction, characterized by severe cutaneous and mucosal blisters and erosions. It often presents with flu-like symptoms, followed by a maculopapular, urticarial, purpuric or erythema multiforme-like eruption, which then evolves into blisters and sheet-like erosions. Presentation with pustules, however, is not well described in the English literature, and may lead to delayed diagnosis. We present two unusual cases of TEN that initially presented with pustular lesions.

Erythema multiforme-like eruption from a slimming drug preparation cutaneous adverse drug reaction

We report a case of a 34-year-old woman presenting with an erythema multiforme (EM)-like eruption. Lesions developed after a 12-day treatment with a slimming drug preparation (food integrator with thermogenic activity) and a herbal remedy (pilosella tincture). Serological investigations excluded viral or bacterial infections. Patch testing with galenic preparations of both drugs demonstrated sensitization to the slimming drug preparation. According to literature reports and immune-chemical properties, those components that are likely to have triggered the skin eruption are clorazepate dipotassium and theobromine. Their interaction with other two constituents such as pseudoephedrine hydrochloride and dehydrocholic acid may have caused the adverse reaction by means of a summation effect. There are no reports specifically about EM caused by a slimming drug preparation and no studies have identified thermogenic pills as cause of EM/EM-like eruption. Weight-loss compounds in slimming preparations should be kept in mind as a possible cause of drug-induced EM-like eruption.

Erythema Multiforme-like Eruption Following Contact Dermatitis to Ginkgo

Erythema Multiforme-like Eruption Following Contact Dermatitis to Ginkgo

A Severe Case of Measles with Erythema Multiforme-like Eruption

A Severe Case of Measles with Erythema Multiforme-like Eruption

A Case of Erythema Multiforme-like Eruption Induced by Verapamil Hydroch loride

A Case of Erythema Multiforme-like Eruption Induced by Verapamil Hydroch loride