Pediatric Lip Adhesion Following Bullous Erythema Multiforme and Review of Similar Oral Complications.

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.

Diagnosis of erythema multiforme associated with thymoma in a dog and treated with thymectomy.

A 7 yr old Labrador retriever initially presented for severe halitosis, mild ptylism, and depigmentation of the nasal planum. Erythema multiforme was diagnosed based on clinical signs and dermatopathology. Treatment was initiated but the condition did not resolve. Six months later, the dog was diagnosed with a mediastinal mass. Trucut biopsy was performed and histopathologic diagnosis was consistent with a thymoma. A median sternotomy was performed, the thymoma was excised, and the dog recovered well. Four months postoperatively, there were no longer any obvious erythema multiforme lesions and the skin condition was controlled without medication. Erythema multiforme may be a paraneoplastic disorder associated with thymoma in the dog, similar to thymoma-associated exfoliative dermatitis in the cat. Clinical signs of erythema multiforme may warrant performing thoracic radiographs or thoracic CT to rule out thymoma as an underlying cause.

Technique for autologous nasal mucosa transplantation in severe ocular surface disease.

PURPOSE: To describe the detailed surgical technique used for harvesting and transplantation of autologous nasal mucosa grafts for ocular surface reconstruction, to evaluate the clinical results and utility of autologous nasal mucosa grafts in ocular surface diseases. METHODS: Autologous nasal mucosa was harvested from either the middle or inferior turbinate. It was transplanted on 11 eyes with severe ocular surface diseases including 4 eyes with chemical burns, 2 eyes with thermal burns, 1 eye with Stevens-Johnson syndrome, 1 eye with erythema multiforme major, and 3 eyes with extensively recurred pterygiums. Clinical outcomes were assessed based on ocular manifestation, epithelization, and visual acuity. RESULTS: The mean follow-up period was 19.9 months (range 13-32 months). Nasal mucosal tissues were safely excised, and their mucosal harvest sites were completely healed in 2 weeks without postoperative complications. All nasal mucosa autograft survived successfully with rapid epithelization, well-developed horizontal vascularization, and abundant mucin secretion. Clinical success, intact ocular surface epithelium without epithelial erosion more than 4 weeks, was achieved in all eyes. There was no recurrence of significant ulceration, conjunctivalization, fibrovascularization, symblepharon, or pterygium. CONCLUSIONS: Goblet cell transplantation using autologous turbinate nasal mucosa presents a promising treatment method in patients with severe ocular surface disorders.

Placas eritematosas escamosas faciales / Erythematous scaly facial plaques

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Autoimmune progesterone dermatitis: treatment with oophorectomy.

Autoimmune progesterone dermatitis is a rare manifestation of hypersensitivity to endogenous hormones with polymorphic clinical manifestations. We report a 28-year-old woman with a 5-year history of mucocutaneous erythema multiforme occurring cyclically in the premenstrual period. Progesterone sensitivity was demonstrated by challenge test with medroxyprogesterone acetate. Treatments with oestrogens, tamoxifen and triptorelin had to be withdrawn because of intolerable adverse effects. Oophorectomy finally cured the disease.