ABSTRACT
Introduction: Bullous erythema multiforme (BEM), an immune-mediated, acute condition, frequently includes erosion affecting the oral, genital, and/or ocular mucosa in addition to discrete target-like lesions on the skin. BEM has been linked to various factors, including infections, medications, malignancy, autoimmune disease, immunization, and radiation. Case presentation: Here, we report a case of a 38-year-old married woman who presented with symptoms of reddish-raised, fluid-filled and painful, nonpruritic lesions along with the swelling of bilateral hand and feet. This patient had a history of taking some unrecorded ayurvedic medication for bloating and abdominal pain in a background of antibiotic use before exhibiting the dermatological symptoms of BEM 2 days later. She was successfully managed with ampicillin and cloxacillin, acyclovir and prednisolone. Clinical discussion: A few incidence of BEM after the administration of amoxicillin has been reported, which precipitated only after consuming ayurvedic medication. BEM has a clinical diagnosis with biopsy rarely required. Here, the hypersensitivity reaction induced by the antibiotic itself or by altering the immune response to the concomitant consumed herbal medicine could explain the BEM. Conclusion: Physicians should note that amoxicillin can trigger BEM, regardless of its use with ayurvedic drugs. Antibiotics should be used with caution, especially in patients with a history of BEM.
ABSTRACT
BACKGROUND: Erythema multiforme (EM) is a mucocutaneous disease most often associated with preceding herpes simplex virus or Mycoplasma pneumoniae infection. It is characterized by targetoid lesions occurring on the limbs and head and neck. Mucosal involvement can be extensive. OBJECTIVE: We report a case of lip adhesion as a complication of EM in a child who required corrective surgery and review similar oral commissure complications. METHODS: We completed a review of the literature for similar cases using PubMed and Medline. CONCLUSIONS AND RELEVANCE: We present the youngest report of lip adhesion due to striking mucositis related to EM. Sequelae of erythema multiforme can be significant, in our case requiring surgery. Meticulous oral hygiene should be encouraged when mucosal lesions are identified.
Subject(s)
Erythema Multiforme , Lip , Adolescent , Child , Erythema Multiforme/pathology , Erythema Multiforme/surgery , Female , Humans , Lip/pathology , Lip/surgery , Male , Mycoplasma pneumoniae , Pneumonia, MycoplasmaABSTRACT
Monoclonal antibodies against the immune checkpoint programmed cell death receptor 1 (PD-1) improve the hosts' antitumor immune response and have showed tremendous promise in the treatment of advanced solid tumors and hematologic malignancies. Reports of serious autoimmune dermatologic toxicities from immune checkpoint blockade therapy, however, are emerging. We report our experience with five patients who presented with pruritic vesicles and blisters on the skin while treated with anti-PD-1 antibody immunotherapy with either nivolumab or pembrolizumab. Four of the patients' skin biopsies revealed subepidermal bullae with immunohistochemical study for type IV collagen labeling the floor of the blister cavity and direct immunofluorescence studies (in three of the four patients tested) decorated linear IgG and C3 immune deposits on the blister roof, diagnostic of bullous pemphigoid. One patient developed bullous erythema multiforme. All patients had partial or complete resolution of skin lesions following treatment with systemic corticosteroid and cessation of checkpoint blockade. Recognition and treatment of rare immune-related bullous dermatologic toxicities will become increasingly important as more patients are treated with effective and newer immune checkpoint blockade therapy.
Subject(s)
Antibodies, Monoclonal, Humanized/adverse effects , Antibodies, Monoclonal/adverse effects , Antineoplastic Agents/adverse effects , Drug Eruptions/etiology , Skin Diseases, Vesiculobullous/chemically induced , Aged , Drug Eruptions/pathology , Female , Humans , Male , Middle Aged , Neoplasms/drug therapy , Nivolumab , Programmed Cell Death 1 Receptor/antagonists & inhibitors , Skin Diseases, Vesiculobullous/pathologyABSTRACT
El Eritema Multiforme (EM) es una reacción cutánea aguda generalmente benigna y autolimitada, asociada a la infección por Virus Herpes Simplex (HSV). Se caracteriza por lesiones polimorfas y tipo diana en extremidades y mucosas. Presentamos un paciente de 22 años con pápulas, vesículas y ampollas, que evoluciona con un 90% de la superficie corporal comprometida en tres semanas. Se realizó una reacción de polimerasa en cadena para HSV, resultando positiva en una costra. La biopsia de piel y la tinción de inmunohistoquímica positiva para linfocitos T CD4, fueron compatibles con EM ampollar asociado a HSV. Destacamos la importancia de la correlación clínico patológica, apoyada por el estudio virológico, en el diagnóstico de este caso de presentación atípica. Los hallazgos de laboratorio confirmaron lo descrito en la literatura respecto de la patogenia del EM asociado a HSV.
Erythema Multiforme (EM) is a generally benign and self-limited acute cutaneous reaction, associated with Herpes Simplex Virus (HSV) infection. It is characterized by polymorphic "target" lesions in extremities and mucosal tissues. We report a 22-year old patient with papules, vesicles and blisters, which evolved to cover 90% of the body in three weeks. We performed a PCR study for HSV, which was positive in a crust. A skin biopsy and positive immunohistochemical stain for LT CD4+ were compatible with bullous EM associated with HSV. We underline the importance of pathological clinical correlation, reinforced by a virological study, in the diagnosis of this case with atypical symptoms. The laboratory findings confirmed literature descriptions with respect to the pathogenicity of EM associated with HSV.
ABSTRACT
In adults, bullous erythema multiforme is most often caused by herpes simplex virus infection, while Stevens-Johnson syndrome is most often associated with drug hypersensitivity. Mycoplasma pneumoniae infection is highly known to be a cause of bullous erythema multiforme and Stevens-Johnson syndrome in children and young adults. To our knowledge, there are only a few reports of bullous erythema multiforme or Stevens-Johnson syndrome induced by M. pneumoniae infection in the Korean literature. We encountered two cases of female children diagnosed as having bullous erythema multiforme associated with M. pneumoniae infection. We also describe an unusual case of Stevens-Johnson syndrome associated with M. pneumoniae infection in a 65-year-old woman.
