Ciprofloxacin induced erythema multiforme: a case report.

Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and other various triggers like flavorings and preservatives, such as benzoic acid and cinnamon, immunologic disorders, such as transient selective C4 deficiency of infancy, collagen diseases, vasculitides, sarcoidosis, non-Hodgkin lymphoma, leukemia, multiple myeloma, myeloid metaplasia, and polycythemia, physical or mechanical factors, such as tattooing, radiotherapy, cold, and sunlight, foods, including salmon berries and margarine, malignancy, and hormonal. EM may be present within a wide spectrum of severity. EM minor represents a localized eruption of the skin with minimal or no mucosal involvement. According to a consensus definition, Stevens-Johnson syndrome (SJS) was separated from the EM spectrum and added to toxic epidermal necrolysis (TEN). The two spectra are now divided into the following: (1) EM consisting of erythema minor and major and (2) SJS/TEN. Ciprofloxacin is a second generation fluoroquinolone. Fluoroquinolones are rapidly bactericidal in vitro and are considerably potent against Escherichia coli and various species of Salmonella, Shigella, Enterobacter, Campylobacter, and Neisseria. Mainly used in urinary tract infections, prostatitis, sexually transmitted diseases, gastrointestinal and abdominal infections, respiratory tract infections, bone-joint and soft tissue infections. Metronidazole is a nitroimidazole antimicrobial medication used particularly for anaerobic bacteria and protozoa. It is on the World Health Organizations list of essential medicines, a list of the most important medications needed in a basic health system. Here we report the case of a 39-year-old male patient who presented with EM to the dermatology outpatient department, Adichunchanagiri Hospital and Research Centre. The patient gave a history of taking antimicrobials ciprofloxacin and metronidazole for the treatment of a non-healing wound on the right leg which he sustained in a road traffic accident. The review of the literature has revealed very rare associations of metronidazole and pantoprazole with EM, but cases of ciprofloxacininduced EM have been reported. Hence, the reported adverse drug reaction has been attributed to ciprofloxacin. In this event, casualty assessment using Naranjo’s scale revealed that ciprofloxacin was a probable cause for the adverse drug reaction.

Coin-shaped epithelial lesions following an acute attack of erythema multiforme minor with confocal microscopy findings.

We report an interesting ocular finding of bilateral multiple coin-shaped epithelial lesions along with the confocal microscopy findings in a patient following an acute attack of erythema multiforme (EM) minor. A 30-year-old male presented with a history of watering and irritation in both eyes of three days duration. He was diagnosed to have EM minor and was on oral acyclovir. Slit-lamp examination revealed multiple coin-shaped epithelial lesions. Confocal microscopy showed a corresponding conglomerate of hyper-reflective epithelial lesions. The corneal lesions resolved over six weeks with oral steroids and acyclovir. An immunological mechanism is suspected.

Eritema multiforme: Conducta odontológica

La incidencia excesivamente elevada de problemas periodontales entre la población, dificulta que un número reducido de especialistas los pueda enfrentar. Se funda como premisa que el cuidado periodontal es, en esencia, labor del odontólogo general y que éste no puede pasar por alto la responsabilidad de proveer atención a todo paciente. Las lesiones vesiculo-ampollares-erosivas a nivel bucal y de piel pueden ser causadas por un amplio grupo de patologías. La etiología de éstas mismas también es muy variable, desde causa traumática-química-por contacto, hasta una causa autoinmune. Ocasionalmente es difícil hacer un diagnóstico diferencial para discernir la etiología de las lesiones, es importante conocer los detalles clínicos y aspectos epidemiológicos e histopatológicos de cada ente. El eritema multiforme es una enfermedad eruptiva inflamatoria mucocutánea, aguda polimorfa y autolimitante, que puede aparecer en: mucosa bucal sólo, varias mucosas, piel sola, o ambas. Puede no ser una entidad etiológica, sino un complejo de síntomas o un patrón de reacción que representa muchos factores posibles, como el estrés, medicamentos o enfermedad sistémica. Representa una urgencia en Odontología. Es importante que el odontólogo, las identifique, así como las consecuencias que ocasiona si no se previenen o tratan a tiempo, así como las complicaciones. El propósito del reporte es describir las diferentes presentaciones clínicas, etiopatogenia, epidemiología, diagnóstico, diferenciales, tratamiento, pronóstico, complicaciones y cuidados postoperatorios. Para ello se realizó basado en los lineamientos de la investigación descriptiva documental, una revisión de la literatura nacional e internacional.

The excessively high incidence on periodontal problems in the population makes it difficult for a reduced number of specialists deal with them. The principal premise is that periodontal care is in essence, the general dentist work and he can not ignore the responsibility to provide adequate attention to every patient. The vesicular-ampulla-erosive lesions in the mouth and skin may be caused by a wide number of pathologies. The ethiology of theses is very variable too, from trauma-chemical contact to an immune cause. Occasionally, it is difficult to make a differential diagnose to know the origin of the injury, it’s important to know all the clinical, epidemiological and histopathological of each entity. The multiforme erithema is an eruptive inflammatory mucocutaneous disease, acute polimorfe and and self-limited that may appear in the mouth mucose only, various mucoses, skin or both. It may not be an ethiological entity, but a group of symptoms or reaction patternthat represents many possible factors, like stress, medicines or systemic disease. It represents an emergency in dentistry. It is important that the dentist identify them as well as their consequences and complications, if they are not treated in time. The purpose of this report is to describe the different clinic presentation, etiology and pathogenesis, epidemiology diagnose, differentials, treatment, prognosis, complications and post surgery care. That’s why a revision of the national and international literature was made based upon on documentary descriptive research techniques.