Endocarditis infecciosa y eritema multiforme minor

El eritema multiforme es una reacción inmunomediada que envuelve la piel y algunas veces a la mucosa. Las infecciones y medicamentos constituyen las causas más comunes. Típicamente se presenta como lesiones "en diana" sobreelevadas con centro pálido y borde eritematoso o lesiones atípicas como vesículas o ampollas. Se presenta el caso de una mujer de 68 años que acude por tumoración a nivel del antebrazo derecho con signos inflamatorios más fiebre, se constata por ecografía aneurisma micótico en dicho miembro y se realiza ecocardiografía transtorácica donde se observan vegetaciones en válvulas aortica y mitral. Durante la internación presenta aparición de lesiones ampollosas con bordes eritematosos distribuidas en tronco y brazos con biopsia que informa erupción liquenoide ampollosa compatible con eritema multiforme minor.

Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Infections and medications are the most common causes. Typically presents as raised "target" lesions with a pale center and erythematous border or atypical lesions such as vesicles or bullae. We present the case of a 68-year-old woman who presented with a tumor on the right forearm with inflammatory signs plus fever, a mycotic aneurysm was confirmed by ultrasound in the limb and a transthoracic echocardiography was performed where vegetations were observed on the aortic and mitral valves. During hospitalization, she presented bullous lesions with erythematous borders distributed on the trunk and arms with a biopsy that reported bullous lichenoid eruption compatible with erythema multiforme minor.

Eritema Multiforme, Una Rara Presentación De Exantema En Población Pediátrica. A Propósito De Un Caso. / Erythema Multiforme, A Rare Occurrence Of Exanthema In The Pediatric Population. On The Subject Of A Case.

El Eritema multiforme (EM) o eritema polimorfo es una enfermedad aguda de la piel de naturaleza inmunológica con o sin compromiso de mucosas, que puede comportarse como crónica recurrente. Se presenta con lesiones cutáneas en diana distintivas, a menudo acompañado de úlceras o bullas en mucosas (oral, genital u ocular). Entre sus formas clínicas se distingue: una forma menor caracterizado por un síndrome cutáneo leve y su forma mayor que se manifiesta como una afectación cutánea con daño mucoso marcado. Entre sus principales diagnósticos diferenciales se encuentran el Síndrome de Stevens-Johnson (SSJ) y Síndrome de Lyell (Necrólisis epidérmica tóxica (NET)). Tiene una incidencia estimada < 1%, siendo su forma mayor levemente más frecuente que su forma menor (0.8-6 por millón/año). Puede darse a cualquier edad, presentando un peak de incidencia entre los 20 y 30 años, predominando ligeramente el sexo masculino con una proporción 3:2, sin predilección racial. Su presentación en edad pediátrica es rara, más aún en la primera infancia. En esta población es más frecuente el EM menor recurrente. En el presente texto se reporta un caso de EM en población pediátrica como una rara forma de presentación exantemática, abordado en el Servicio de Pediatría del Complejo Asistencial Dr Victor Rios Ruiz (CAVRR)en la ciudad de Los Ángeles, Chile en el presente año.

Erythema multiforme (EM) also known as polymorph erythema is an acute skin disease of immunological nature with or without mucous membrane involvement, which may behave as chronic recurrent. It presents with distinctive targets like skin lesions, often together with ulcers or bullae in mucous membranes (oral, genital or ocular). Among its clinical forms are: a minor form characterized by a mild skin syndrome and its major form that manifests as a skin disease with marked mucosal damage. Among its main differential diagnoses are Stevens-Johnson Syndrome (SJS) and Lyell Syndrome (Toxic Epidermal Necrolysis (TEC)). It has an estimated incidence < 1%, with its major form being slightly more frequent than its minor form (0. 8-6 per million/year). It can occur at any age, presenting a peak incidence at the age between 20 and 30 years, with a slight predominance of males with a 3:2 ratio, without racial predilection. Its presentation in pediatric age is rare, even more so in early childhood. Minor recurrent EM is more common in this population. This paper reports a case of EM in the pediatric population as a rare form of exanthematic presentation, addressed at the Department of Pediatrics of the Complejo Asistencial Victor Rios Ruiz (CAVRR) in the city of Los Angeles, Chile this year.

Post nirmatrelvir/ritonavir erythema multiforme in a patient with coronavirus disease infection

ABSTRACT Erythema multiforme (EM), an immune-mediated skin condition, can occur after infection or following the use of medications. In this study, we describe a patient who developed EM after nirmatrelvir/ritonavir administration. An 81-year-old woman presented with fever and dyspnea. Laboratory investigations showed positive coronavirus disease (COVID-19) based on polymerase chain reaction assay, and she received a 5-day regimen of nirmatrelvir/ritonavir. We observed development of EM after this treatment and initiated prednisone (1 mg/kg) therapy, which led to rapid improvement. Our study is the first to report EM in a patient with COVID-19, who received nirmatrelvir/ritonavir and showed a favorable response.

Mycoplasma pneumoniae?induced rash and mucositis: A new entity

Mycoplasma pneumoniae is a well-known cause of community-acquired pneumonia, mostly associated with dermatological manifestations especially with mucosal involvement and targetoid cutaneous lesions. For many years, it was considered among the spectrum of erythema multiforme. Recently, some authors have recommended the creation of a new syndrome called “mycoplasma-induced rash and mucositis.” This new syndrome has distinct epidemiological, clinical and histological features making it different from drug-induced Stevens-Johnson syndrome, toxic epidermal necrosis and erythema multiforme. Herein, we report two patients with acute Mycoplasma pneumoniae respiratory tract infection presenting severe mucocutaneous lesions in accordance with this new syndrome.

Oral Manifestations of Erythema Multiforme due to Methotrexate Intoxication

ABSTRACT: To report a rare case of erythema multiforme (EM) associated with methotrexate (MTX) with cutaneous and oral manifestations and to compare it to existing cases in which MTX was not used for cancer treatment. A 56-years- old female, in physical examination skin lesions and multiple oral ulcers associated with pain during manipulation were observed, and underwent treatment for rheumatoid arthritis with Methotrexate 2.5mg. During examination patient-reported that 15 days ago she had undergone a rheumatoid factor examination, doubling the MTX dosage (10mg / day) without doctor's consent. The diagnostic hypothesis of EM. The medical conduct consisted of the suspension of MTX and prescription of a vitamin complex with folinic acid. Local dental therapy for to control oral lesions, pain control and lip hydration was performed using low-level laser therapy (Twin Laser, P: 40mW, T: 50s, DE: 50J / cm), benzydamine hydrochloride spray, purified lanolin for lip dryness, and toothpaste without sodium lauryl sulfate to prevent burning. After 12 days, there was significant remission of oral and skin signs and symptoms, which confirmed the diagnosis was EM due to MTX intoxication. Thorough clinical evaluation and anamnesis favored diagnosis and early multi-professional management provided remission of oral and skin lesions, prevented systemic complications.

RESUMEN: El objetivo de este trabajo fue informar un caso raro de eritema multiforme (EM) asociado a metotrexato (MTX) con manifestaciones cutáneas y orales y compararlo con casos existentes en los que no se utilizó MTX para el tratamiento del cáncer. Caso clínico: Mujer de 56 años, en el examen físico se observaron lesiones cutáneas y múltiples úlceras de la cavidad oral asociadas a dolor durante la manipulación.Se sometió a tratamiento para la artritis reumatoide con metotrexato 2,5 mg. Durante el examen, la paciente informó que hacía 15 días se había sometido a un examen de factor reumatoide, duplicando la dosis de MTX (10 mg / día) sin el consentimiento del médico. La hipótesis diagnóstica de EM. La conducta médica consistió en la suspensión de MTX y prescripción de un complejo vitamínico con ácido folínico. La terapia dental local para el control de las lesiones orales, el control del dolor y la hidratación de los labios se realizó mediante terapia con láser de bajo nivel (Twin Laser, P: 40mW, T: 50s, DE: 50J / cm), aerosol de clorhidrato de bencidamina, lanolina purificada para la sequedad de labios y pasta de dientes sin lauril sulfato de sodio para evitar quemaduras. Después de 12 días, hubo una remisión significativa de los signos y síntomas orales y cutáneos, lo que confirmó el diagnóstico de ME por intoxicación por MTX. La evaluación clínica exhaustiva y la anamnesis favorecieron el diagnóstico y el manejo multiprofesional precoz proporcionó la remisión de las lesiones orales y cutáneas, evitando además complicaciones sistémicas.

Dermatological Manifestations of COVID-19 in Children

Context: The clinical picture of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection differs from adults as do the cutaneous manifestations. In this review, we summarize the varied morphological manifestations of SARS-CoV-2 infection in the pediatric population. Evidence acquisition: A comprehensive literature search was conducted (23 September, 2021) across multiple databases (PubMed, EMBASE, MEDLINE and Cochrane) with the relevant keywords. An additional filter of age group between 0-18 years was kept in each of the searches. Results: Chilblains constitute the most common cutaneous manifestation of pediatric coronavirus disease (COVID-19). Other commonly reported manifestations include maculopapular rash, urticaria, erythema multiforme, and papulovesicular eruptions. Majority of children with these manifestations are asymptomatic, highlighting the need to clinically suspect and appropriately manage such patients. A subset of pediatric patients develop severe multisystem involvement termed as multi-system inflammatory syndrome in children (MIS-C) that has varied mucocutaneous manifestations. Conclusion: A wide variety of dermatological manifestation of SARS-CoV-2 infection is reported, and both the pediatrician and dermatologist need to be aware of the same to suspect and diagnose COVID-19 infection in children.

Eritema multiforme como manifestación paraneoplásica de un adenocarcinoma de colon

RESUMEN: El eritema multiforme es una enfermedad autoinmune vesicular-ampollosa y autolimitada, se presenta de forma aguda afectando la piel y mucosa. En 2015, Lee E. y Freer J., incluyeron esta enfermedad dentro de los síndromes dermatológicos paraneoplásicos, pero actualmente no existen muchas publicaciones de esta entidad como manifestación a una neoplasia subyacente. El objetivo de esta investigación es presentar el eritema multiforme como una manifestación paraneoplásica inusual. En este caso una paciente de 64 años de edad que cursaba con adenocarcinoma de colon exhibió el eritema multiforme oral; cuyas manifestaciones bucales involucionaron gracias a la farmacoterapia local y sistémica en conjunto con la excéresis de la lesión cancerosa en el colon. Es importante reconocer la presencia de eritema multiforme como una manifestación paraneoplásica cuando no se exhiben los factores etiológicos frecuentes de esta patología y, por lo tanto, centrarse en la búsqueda subyacente de neoplasias malignas que no son muy evidentes.

ABSTRACT: Erythema multiforme is a self-limiting, blistering, autoimmune disease that presents acutely, affecting the skin and mucosa. In 2015, Lee E. and Freer J. included this disease in paraneoplastic dermatological syndromes, but there are currently not many publications about this entity as a manifestation of an underlying malignancy. The objective of this research is to present the erythema multiforme as an unusual paraneoplastic manifestation. In this case, a female 64-year-old patient with colon adenocarcinoma exhibited oral multiform erythema; whose oral manifestations regressed thanks to local and systemic pharmacotherapy in conjunction with the exeresis of the cancerous lesion in the colon. It is important to recognize the presence of erythema multiforme as a paraneoplastic manifestation when the frequent etiological factors of this pathology are not exhibited and, therefore, to focus on the underlying search for malignant neoplasms that are not very evident.

Clinical features and prognosis of eight cases of Mycoplasma pneumoniae-induced rash and mucositis / 中华皮肤科杂志

Objective:To analyze clinical features and prognosis of Mycoplasma pneumoniae-induced rash and mucositis (MIRM) . Methods:Among patients who were diagnosed with erythema multiforme/severe erythema multiforme or Stevens-Johnson syndrome at discharge from the First Affiliated Hospital, Sun Yat-sen University from November 2004 to May 2021, patients with MIRM were screened out according to diagnostic criteria for MIRM and after exclusion of other causes, and their clinical manifestations, laboratory and auxiliary examinations, treatment and prognosis were analyzed.Results:Eight patients were found to meet the MIRM diagnostic criteria, including 4 males and 4 females, with the age at onset being 15.63 ± 9.16 years (range, 4 - 30 years) . All the 8 patients had fever, and 5 of them had upper respiratory symptoms such as cough and sore throat. Oral mucosal damage occurred in all the patients, 5 of whom presented with blood crusts on the lips; eye damage occurred in 7 patients, which manifested as conjunctiva hyperemia and increased secretions. All the patients presented with skin lesions, including 5 with targetoid lesions and 4 with blisters. All the patients were serologically positive for anti- Mycoplasma pneumoniae IgM. One patient experienced recurrent upper respiratory tract infections such as dry cough, each episode was closely related to Mycoplasma pneumoniae infection, and whole exome sequencing of the peripheral blood showed heterozygous mutations in the NLRC4 and IRGM genes. Histopathological examination of skin lesions was performed in 3 patients, and the results were consistent with the diagnosis of erythema multiforme. Seven patients were treated with systemic glucocorticoids, 6 with intravenous immunoglobulin, 5 with azithromycin, and 5 with acyclovir, valacyclovir or ribavirin. After an average 2.9-year follow-up, 3 patients were cured, 1 was blind, 1 experienced recurrent dry cough, oral ulcers and rashes on the limbs, and the remaining 3 developed eye damage such as meibomian gland dysfunction, punctal stenosis and corneal epithelial damage. Conclusions:MIRM mostly occurred in children and young adults, and was mainly accompanied by prodromal symptoms such as fever, sore throat and cough. MIRM mainly manifested as obvious mucosal damage and some targetoid lesions. Most patients could recover after a single attack, and recurrent episodes may be related to mutations in autoinflammation- and infection-related genes in some patients.

Recurring oral erythema multiforme-like lesions elicited by COVID-19 infection: a case report / Lesões semelhantes a eritema multiforme oral recorrente induzidas por infecção por COVID-19: relato de caso

Oral mucosa could be the first site infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ­the causative agent of coronavirus disease 2019 (COVID-19). Indeed, different oral and paraoral lesions, conditions and symptoms have been reported in patients with COVID-19. Experts thought that such oral lesions could be secondary to the COVID-19-associated deterioration of systemic health or due to treatments of COVID-19. We present here a case of a 24-year-old male presented with painful multiple ulcers involving the labial and buccal mucosae bilaterally after a while of feeling very mild symptoms that laboratory-confirmed by reverse-transcription polymerase chain reaction to be COVID-19. Involvement of eyes was also reported. The above clinical presentation was consistent with minor erythema multiform. Many topical preparations were prescribed but with limited improvement. Hence, oral prednisolone was prescribed with a 40-mg loading dose that was tapered by 10 mg every 3 days. Complete healing of oral mucosa was observed on the 10 day. Strikingly, the patient got affected with the second episode of similar oral lesions 5 months later without any apparent triggering factors, suggestive a long term effects of COVID-19 in a subset of patients. The present case report provides dentists with useful information and increases their awareness regarding possible involvement of oral cavity with multiple ulcerative lesions associated with COVID-19 (AU)

A mucosa oral pode ser o primeiro local infectado com a síndrome respiratória aguda grave coronavírus 2 (SARS- CoV-2) ­ o agente causador da doença por coronavírus 2019 (COVID-19). De fato, diferentes lesões, condições e sintomas orais e paraorais foram relatados em pacientes com COVID-19. Os especialistas pensavam que essas lesões orais poderiam ser secundárias à deterioração da saúde sistêmica associada ao COVID-19 ou devido a tratamentos do COVID-19. Apresentamos aqui um caso de um homem de 24 anos que apresentou múltiplas úlceras dolorosas envolvendo bilateralmente as mucosas labial e bucal após um tempo sentindo sintomas muito leves que foram confirmados laboratorialmente pela reação em cadeia da polimerase de transcrição reversa como COVID-19. O envolvimento dos olhos também foi relatado. A apresentação clínica acima foi compatível com eritema multiforme menor. Muitas preparações tópicas foram prescritas, mas com melhora limitada. Assim, foi prescrito prednisolona oral com uma dose inicial de 40 mg que foi reduzida em 10 mg a cada 3 dias. A cicatrização completa da mucosa oral foi observada no 10º dia. Surpreendentemente, o paciente foi afetado com o segundo episódio de lesões orais semelhantes 5 meses depois, sem nenhum fator desencadeante aparente, sugerindo efeitos de longo prazo do COVID-19 em um subconjunto de pacientes. O presente relato de caso fornece aos dentistas informações úteis e aumenta sua conscientização sobre o possível envolvimento da cavidade oral com múltiplas lesões ulcerativas associadas ao COVID-19 (AU)

Aplicação do laser de baixa intensidade no tratamento do eritema multiforme: relato de caso / Low intensity laser application in the treatment of erythema multiforme: case report

Objetivo: Este trabalho tem como objetivo relatar um caso de Eritema Multiforme (EM) menor desencadeado por amoxicilina oral, tratado a partir de aplicação de laser de baixa intensidade na região afetada pela doença. Relato de caso: Paciente de 12 anos, atendido no Hospital Metropolitano Odilon Behrens (HMOB), apresentando úlceras em mucosa jugal, lábios e língua, disfagia, dislalia e febre, recebeu diagnóstico clínico de EM e tratamento com aplicação de laser vermelho de baixa intensidade, emitindo em 660nm, com potência de 100mW, sendo aplicado uma dose de 33 J/cm², em pontos com distância aproximada de 1 cm entre eles. Houve resolução das lesões em 7 dias após instituição do tratamento. Conclusão: O presente trabalho mostrou que a Terapia de Fotobiomodulação (TF) com laser de baixa intensidade associado à substituição do medicamento detectado como causa foram fundamentais para a resolução do EM, evidenciando as propriedades bioestimulantes do laser nas lesões ulceradas de mucosa bucal.

Aim: This paper aims to report a case of minor Erythema Multiforme (EM) triggered by oral amoxicillin, treated with low-level laser applications in the region affected by the disease. Case report: A 12-year-old patient, treated at the Metropolitan Hospital Odilon Behrens, presenting ulcers in the buccal mucosa, lips, tongue, dysphagia, dyslalia, and fever, received a clinical diagnosis of EM and treatment with low-intensity red laser applications, emitted at 660 nm, with a power of 100 mW, with a dose of 33 J/cm² being applied, in points with an approximate distance of 1 cm between them. The lesions resolved within 7 days after treatment were instituted. Conclusion: This present paper shows a successful therapeutic, non-pharmacological alternative for the management of EM, showing the bio stimulating properties of laser in ulcerated lesions of the oral mucosa.

Stevens-Johnson syndrome and herpes simplex reactivation associated with paracetamol use. Case report / Síndrome de Stevens-Johnson con reactivación de herpes simple asociado a la ingesta de paracetamol. Reporte de caso

Abstract Introduction: Stevens-Johnson syndrome (SJS) is a rare disease that affects the skin, as well as the oral, ocular, and urogenital mucous membranes. This condition is caused by drug reactions in more than 50% of cases. Case presentation: A 20-year-old male visited the emergency service of a tertiary care hospital of Popayán due to a 10-day history of asthenia, adynamia, fever (without objective measurement records), cough with scarce whitish sputum, and headache that improved with paracetamol treatment. However, his condition worsened in the last two days, and he developed hyporexia, pharyngeal pruritus, vesicles, and blisters on the corners of the mouth, the oral mucosa, the trunk, and limbs, as well as breathing difficulty and odynophagia, prompting him to seek medical treatment at the ER. At first, disseminated herpes simplex, systemic lupus erythematosus and SJS were suspected, but based on clinical and laboratory findings, the patient was finally diagnosed with SJS with herpes simplex reactivation associated with the use paracetamol. Consequently, the administration of this drug was stopped and management with acyclovir and methylprednisolone was started. The patient progressed satisfactorily and was discharged 10 days after beginning the new treatment, and his general condition was optimal during follow-up appointments. Conclusion: The occurrence of SJS may be associated with the oral administration of paracetamol; nevertheless, its use is not discouraged due to its great overall benefits. In this sense, given that paracetamol is an over-the-counter drug widely used in Colombia, recognizing the clinical manifestations of SJS is essential to provide adequate management and avoid complications in cases such as the one reported here.

Resumen Introducción. El síndrome de Stevens-Johnson (SJS) es una enfermedad poco común que afecta la piel y las mucosas oral, ocular y urogenital; además, en más del 50% de los casos es producida por reacciones a medicamentos. Presentación del caso. Hombre de 20 años quien asistió al servicio de urgencias de un hospital de tercer nivel de Popayán (Colombia) por un cuadro clínico de 10 días de evolución consistente en astenia, adinamia, fiebre no cuantificada, tos con escasa expectoración blanquecina y cefalea, sintomatologia que mejoraba con el uso de paracetamol; sin embargo, la condición del paciente empeoró en los últimos dos días, presentando hiporexia, prurito en faringe, vesículas y ampollas en comisuras labiales, mucosa oral, tronco y extremidades, además de dificultad respiratoria y odinofagia, razón por la cual acudió al servicio. En principio de sospechó de herpes simple diseminado, lupus eritema-toso sistêmico, y SJS; sin embargo, con base en los hallazgos clínicos y de laboratorio se confirmó el diagnóstico de SJS con reactivación de herpes simple asociado a la ingesta de paracetamol, por lo que se suspendió este medicamento y se inició manejo con aciclovir y metilprednisolona. El paciente tuvo una evolución satisfactoria y fue dado de alta a los 10 días del inicio del nuevo tratamiento y en las citas de control su condición general era óptima. Conclusiones. El desarrollo de SJS puede estar asociado al consumo de paracetamol; sin embargo, su uso no se desaconseja gracias a sus grandes bondades y beneficios generales. En este sentido, dado que el paracetamol es un medicamento de venta libre y uso extenso en Colombia, es indispensable reconocer las manifestaciones clínicas del SJS para poder dar un manejo adecuado y evitar complicaciones en casos como el aquí reportado.

Pityriasis rubra pilaris post-infection due COVID-19: case report / Pitiriasis rubra pilaris post-infección por COVID-19: reporte de un caso

Abstract Case description: 32-month-old boy, IgG positive for SARS-CoV-2, presented to the emergency department with dermatologic lesions. Clinical findings: Four days before admission, he presented skin eruptions with redness and pruritus on hands and feet. Generalized papular erythema was evidenced, upper extremities with diffuse erythematosquamous plaques, palmoplantar keratoderma, so he was evaluated by a dermatologist who diagnosed pityriasis rubra pilaris. Treatment and outcome: rehydrating cream, cetirizine 0.5 mg/kg/day every two days, and prednisolone 2 mg/kg/day in the morning. He was discharged after 14 days, the patient presented clinical improvement, but the erythematous lesion persisted on the trunk and extremities. In the evaluation, after three months, the patient did not show the described lesions, evidencing an improvement and clinical resolution of the dermatological problems. Clinical relevance: We report a patient with pityriasis rubra piloris associated with a post-infection by SARS-CoV-2 that had not been described before.

Resumen Descripción del caso: Niño 32 meses de vida, con IgG positivo para SARS-CoV-2, acude al servicio de emergencia por presentar lesiones dermatológicas. Hallazgos clínicos: Cuatro días antes del ingreso presentó erupciones en la piel, con enrojecimiento y prurito en manos y pies. Se evidenció eritema papular generalizado, extremidades superiores con placas eritematoescamosas difusas, queratodermia palmo-plantar por lo que es evaluado por dermatólogo quien diagnostica pitiriasis rubra pilaris. Tratamiento y resultado: Crema rehidratantes, cetirizina 0.5 mg/kg/día cada 2 días y prednisolona 2 mg/kg/día por la mañana. Fue dado de alta a los 14 días, el paciente presenta mejora clínica, pero aún persiste la lesión eritematosa en tronco y extremidades. En la evaluación a los tres meses el paciente no mostró las lesiones descritas, evidenciando una mejoría y resolución clínica de los problemas dermatológicos. Relevancia clínica: Se reporta un paciente con afectación por pitiriasis rubra piloris asociado a una post-infección por SARS-CoV-2 que no se había descrito antes.

Treatment Following Erythema Multiforme in the Oral Mucosa After qHPV Vaccine with Low-Level Laser Therapy: Case Report

ABSTRACT: Erythema multiforme (EM) is a mucocutaneous condition of uncertain etiology, although the hypersensitivity reaction to a wide variety of agents may be related to the onset of the lesions. In about half of the affected patients it is possible to identify a previous infection. This article aims to report a case of EM in the oralmucosa after qHPV vaccine (Gardasil®), to highlight the diagnostic process and the proposed treatment. Female patient, 16 years old, after 10 days of receiving the first dose of the qHPV vaccine. On physical examination, she presented multiple ulcers and hemorrhagic crusts to the touch, based on the clinical picture and the history of the disease, a diagnostic hypothesis was EM. Low-level laser therapy (LLLT) was chosen as an alternative treatment, since the exercises applied were not successful. The patient was followed up, reported decreased pain and burn and, after one year of treatment, there was no recurrence of the lesions. Laser treatment showed an effective treatment alternative, in addition to the low cost and ease of application.

RESUMEN: El eritema multiforme (EM) es una afección mucocutánea de etiología incierta, aunque la reacción de hipersensibilidad a una amplia variedad de agentes puede estar relacionada con la aparición de las lesiones. En aproximadamente la mitad de los pacientes afectados es posible identificar una infección previa. Este artículo tiene como objetivo informar un caso de EM en la mucosa oral después de la vacuna qHPV (Gardasil®), para resaltar el proceso de diagnóstico y el tratamiento propuesto. Paciente de 16 años, después de 10 días de recibir la primera dosis de la vacuna qHPV. En el examen físico, presentó múltiples úlceras y costras hemorrágicas al tacto, según el cuadro clínico y la historia de la enfermedad, una hipótesis diagnóstica fue EM. La terapia con láser de baja potencia (TLBP) se eligió como un tratamiento alternativo, ya que los ejercicios aplicados no tuvieron éxito. La paciente fue seguida, informó disminución del dolor y las quemaduras y, después de un año de tratamiento, no hubo recurrencia de las lesiones. El tratamiento con láser mostró una alternativa de tratamiento efectivo, además del bajo costo y la facilidad de aplicación.

Lupus eritematoso asociado a eritema multiforme: Síndrome de Rowell. Reporte del primer caso en Chile

Rowell's syndrome is characterized by an association of lupus erythematosus and erythema multiforme, with distinctive laboratory findings. Its treatment is similar to lupus. We report a 16-year-old female presenting with skin lesions, laboratory and histology consistent with this entity. Because of the spread of cutaneous involvement and development of epidermal detachment, she required therapy with intravenous corticosteroids and gamma globulin.

Eritema multiforme limitado à cavidade oral em um cão: relato de caso / Multiforme erythema limited to the oral cavity in a dog: case report

O eritema multiforme é uma doença incomum em cães, que afeta pele e mucosas, cuja etiologia ainda não foi completamente elucidada. Contudo, o envolvimento exclusivo da cavidade oral é considerado raro, tendo sido descrito poucas vezes até o presente momento. O objetivo deste trabalho é descrever um caso de eritema multiforme limitado à cavidade oral em um canino. Um cão, fêmea, Akita, com sete anos de idade, apresentou histórico de ulcerações na cavidade oral e nas laterais da língua, sem alterações cutâneas ou sistêmicas. O diagnóstico definitivo foi realizado por meio do exame histopatológico da mucosa oral, e a terapia imunossupressora empregada mostrou-se eficaz. Embora o eritema multiforme seja considerado incomum na espécie canina, este relato de caso apresenta a forma mais rara da doença, com poucos casos descritos em medicina veterinária.(AU)

Multiforme erythema is an uncommon disease in dogs that affects the skin and mucous membranes, the etiology of which has not yet been fully elucidated. However, the exclusive involvement of the oral cavity is considered rare, having been described few times until the present moment. The aim of this work is to describe a case of multiforme erythema limited to the oral cavity in a canine. A seven-year-old female dog, akita, presented a history of ulcerations in the oral cavity and on the sides of the tongue, with no cutaneous or systemic changes. The definitive diagnosis was made through the histopathological examination of the oral mucosa and the immunosuppressive therapy used proved to be effective. Although multiforme erythema is considered uncommon in the canine species, this case report presents the rarest form of the disease, with few cases described in veterinary medicine.(AU)

Síndrome de Lyell em 72% de superfície corporal / Lyell syndrome in 72% of the body surface

Introdução: A síndrome de Lyell é caracterizada por flictenas em mais de 30% de superfície corporal e acomete mucosas. Está relacionada à reação alérgica decorrente de medicamentos e apresenta alta mortalidade. Relato de caso: Mulher de 28 anos apresentou flictenas em 72% de superfície corporal após uso de diversos fármacos. Apesar da grande extensão, a paciente evoluiu de maneira satisfatória e recebeu alta sem sequelas. Conclusão: É fundamental o diagnóstico precoce, a estratificação e a conduta para reduzir a mortalidade da doença.

Introduction: Lyell's syndrome is characterized by phlyctenas on more than 30% of the body surface and by involvement of the mucous membranes. It is related to the allergic reaction resulting from medications and has a high mortality. Case report: A 28-year-old woman presented phlyctenas on 72% of the body surface after using various drugs. Despite a great extent, the patient progressed satisfactorily and was discharged without sequelae. Conclusion: Early diagnosis, stratification, and management are essential to reduce mortality from the disease.

Unexpected patch test complication: onset of erythema multiforme-like lesions / Complicação inesperada após teste de contato: aparecimento de lesões eritema multiforme-símile

Erythema multiforme is generally associated with infections and drugs. Although less common, there are also reported cases of this disorder after patch testing. We described a 22 year-old female patient who, 24 hours after patch testing, progressed to erythematous iris-shaped plaques and papules with central crust, symmetrically distributed over her hands, arms, and back, with severe itch. The erythema multiforme-like lesions presented in the case were interpreted as a manifestation of systemic allergic contact dermatitis secondary to the exam. Allergic contact dermatitis may be manifested as an erythema multiforme in a hypersensitive person. Few cases of systemic allergic contact dermatitis after patch testing have been reported, for example, due to diethyl thiourea, some textile disperse dyes, and povidoneiodine. The development of erythema multiforme is not noted in most literature references as a complication after patch testing. Although unusual, this disorder needs to be considered as a potential adverse effect of this exam.

O eritema multiforme está associado comumente a infecções e medicamentos. Embora menos comum, também há casos relatados dessa doença após aplicação do teste de contato. Descrevemos uma paciente de 22 anos que evoluiu, em 24 horas após o teste, com placas e pápulas eritematosas, em formato de íris e crosta central, distribuídas simetricamente nas mãos, braços e costas, além de prurido intenso. As lesões eritema multiformesímile presentes no caso foram interpretadas como uma manifestação alérgica secundária ao exame. Dermatite de contato alérgica pode se manifestar como um eritema multiforme em pessoas hipersensíveis. Poucos casos de dermatite alérgica de contato sistêmica foram relatados após este exame, por exemplo, devido às seguintes substâncias: dietil tioureia, corantes dispersos têxteis e iodopovidona. O desenvolvimento do eritema multiforme não é usualmente apontado como uma complicação do teste de contato alérgico, na maioria das referências literárias. Embora incomum, o surgimento dessa desordem após este exame necessita ser considerado como um efeito adverso.

A case of urticaria multiforme with unusual presentation

Urticaria multiforme is a condition which manifests as acute, polycyclic, annular oedematous pink plaques with an ecchymosis hue that is associated with acral edema. The condition is often misdiagnosed as erythema multiforme, serum-sickness-like reactions, or urticarial vasculitis. Author present a case of acute annular urticaria in a 3-year-old girl who presented with unusual clinical manifestations of the condition. Through this case report, Author aim to emphasize the wide range of morphologic manifestations that can be seen in urticaria multiforme. This can assist pediatric physicians to differentiate urticaria multiforme from other clinical dermatologic conditions and prevent misdiagnosis. A detailed case history and physical examination, along with relevant diagnostic tests can enable prompt and effective management of the condition.

Eritema Multiforme por Parvovirus B19 / Erithema Multiforme by Parvovirus B19

RESUMEN El Parvovirus B 19 es un virus de la familia Parvoviridae que se disemina por vía respiratoria. La infección es frecuente durante la niñez, y la seroprevalencia aumenta con la edad. Causa diversas manifestaciones clínicas según el estado inmunológico y hematológico del paciente, y la mayoría de las infecciones son asintomáticas. Se presenta el caso de una mujer adulta que presentó lesiones en diana tipo eritema multiforme e infección primaria por Parvovirus B 19.

SUMMARY Parvovirus B19 is a virus of the family Parvoviridae that spreads by respiratory route. The infection is more common during childhood and the seroprevalence increases with age. It causes a wide range of diseases according to the immunologic and hematologic patient`s status. Most of infections are asymptomatic. We report a female adult patient who presents for evaluation and management with multiple overspread eritematous asymptomatic target lesions like erythema multiforme associated with Parvovirus B 19 infection.