RESUMO
Erythema multiforme (EM) is an immune-mediated mucocutaneous condition characterized by hypersensitivity reactions to antigenic stimuli from infectious agents and certain drugs. The most commonly implicated infectious agents associated with EM include herpes simplex virus (HSV) and Mycoplasma pneumoniae. Other infectious diseases reported to trigger EM include human immunodeficiency virus (HIV) infection and several opportunistic infections. However, studies focusing on EM and human immunodeficiency virus (HIV) infection are scarce. even though the incidence of EM among HIV-infected individuals have increased, the direct and indirect mechanisms that predispose HIV-infected individuals to EM are not well understood. In turn, this makes diagnosing and managing EM in HIV-infected individuals an overwhelming task. Individuals with HIV infection are prone to acquiring microorganisms known to trigger EM, such as HSV, Mycobacterium tuberculosis, Treponema pallidum, histoplasmosis, and many other infectious organisms. Although HIV is known to infect CD4 + T cells, it can also directly bind to the epithelial cells of the oral and genital mucosa, leading to a dysregulated response by CD8 + T cells against epithelial cells. HIV infection may also trigger EM directly when CD8 + T cells recognize viral particles on epithelial cells due to the hyperactivation of CD8 + T-cells. The hyperactivation of CD8 + T cells was similar to that observed in drug hypersensitivity reactions. Hence, the relationship between antiretroviral drugs and EM has been well established. This includes the administration of other drugs to HIV-infected individuals to manage opportunistic infections. Thus, multiple triggers may be present simultaneously in HIV-infected individuals. This article highlights the potential direct and indirect role that HIV infection may play in the development of EM and the clinical dilemma that arises in the management of HIV-infected patients with this condition. These patients may require additional medications to manage opportunistic infections, many of which can also trigger hypersensitivity reactions leading to EM.
Assuntos
Eritema Multiforme , Infecções por HIV , Infecções Oportunistas , Humanos , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Simplexvirus , Infecções Oportunistas/complicaçõesRESUMO
Several reports stated that erythema multiforme (EM) was associated with COVID-19 with detrimental outcomes in patients. However, since most of these are case reports, it is challenging to quantitively assess their associations. Therefore, our study aims to determine the prevalence of EM in the context of COVID-19. The study was designed as a retrospective cross-sectional hospital-based study of registered patients at the University of Florida Health Hospital. The ICD-10 codes for EM, COVID-19 infection, and COVID-19 vaccines were searched in the database. The odds ratio was calculated to assess the risk of EM after COVID-19 infection or vaccination. Our study included 43,547 patients with a history of COVID-19 infection, of whom 92 developed EM. Patients with COVID-19 infection were 6.68 times more likely to have EM than those without COVID-19 (P < 0.0001). Similarly, the risk of developing EM after COVID-19 vaccination was 2.7, significantly higher than the general population (P < 0.0001). The prevalence of EM following COVID-19 infection or vaccination significantly differs from the general population, highlighting the importance of monitoring patients for EM after COVID-19 infection and/or vaccination. It is imperative to disseminate awareness to clinicians and patients regarding the impact of COVID-19 on EM.
Assuntos
COVID-19 , Eritema Multiforme , Humanos , Vacinas contra COVID-19/efeitos adversos , Estudos Retrospectivos , Prevalência , Estudos Transversais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/complicações , Eritema Multiforme/epidemiologia , Eritema Multiforme/etiologia , Vacinação/efeitos adversosRESUMO
A 16-year-old female patient presented to the orthodontic department with a 2-week history of painful oral lesions that were affecting her ability to eat. Clinical examination revealed widespread oral ulceration, crusted bleeding from the lips with evidence of a herpes simplex infection in the region of the right buccal commissure. A diagnosis of oral erythema multiforme (EM) was made after a detailed clinical history and examination by the oral and maxillofacial team. Supportive care was provided alongside management with topical corticosteroids. Within 6 weeks of initial presentation, complete resolution of the lesions had occurred and the patient was able to resume active orthodontic treatment.
Assuntos
Eritema Multiforme , Humanos , Feminino , Adolescente , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Eritema Multiforme/patologiaRESUMO
Radiation dermatitis, limited to the irradiated site, is the most common cutaneous adverse reaction due to radiotherapy. There are scattered reports of erythema multiforme-like rash, Stevens-Johnson syndrome, and toxic epidermal necrolysis associated with radiotherapy. Some of these reports include cases without remarkable drug history, which suggests rashes induced by radiotherapy. The lack of a large cohort study, however, makes it difficult to ascertain the time course, severity, and outcome of the cases. We aimed to evaluate the potential association between radiotherapy and erythema multiforme-like rash in a larger sample of patients. We examined the records of patients at our institute who received radiotherapy and developed a rash from 2010 to 2021. We present 30 patients with erythema multiforme-like rash, which arose during or after radiotherapy. We describe the background, details of radiotherapy, and clinical course of the patients including the cutaneous and extracutaneous symptoms. Radiotherapy was the most likely cause of rash, and in most cases, the rash was relieved by conservative management and radiation could be continued. When erythema multiforme-like rash arises in patients under cancer treatment, radiotherapy should be considered a potential trigger.
Assuntos
Eritema Multiforme , Exantema , Neoplasias , Síndrome de Stevens-Johnson , Humanos , Estudos de Coortes , Neoplasias/radioterapia , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Exantema/diagnóstico , Exantema/etiologia , Tratamento Conservador , Síndrome de Stevens-Johnson/etiologiaRESUMO
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.
Assuntos
Humanos , Feminino , Criança , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Eritema Multiforme/terapia , Corticosteroides/uso terapêutico , Síndrome de Stevens-Johnson , Alergia e Imunologia , Exantema/etiologia , Exantema/etnologiaRESUMO
PURPOSE: The aim of this study was to describe the diagnosis and management of bilateral blepharoconjunctivitis and erythema multiforme (EM)-like illness in an otherwise healthy young man who tested positive for severe acute respiratory syndrome coronavirus (SARS-CoV)-2. METHODS: This is a case report of a 27 year-old man with a positive result for SARS-CoV-2 testing who presented with fever, eye redness, oral ulcerations, cough, sore throat, and progressive rash suspicious for EM-like illness. RESULTS: A SARS-CoV-2-positive patient presented to the emergency room with a progressing skin rash, bilateral conjunctivitis, and oropharyngeal mucosal ulcers. On initial ophthalmic examination, visual acuity was 20/25 both eyes (OU), and slit lamp examination demonstrated erythema and ulceration of the eyelid margins with fluorescein uptake at the mucocutaneous junction OU. The patient was admitted for observation and supportive treatment. During and after his hospital stay, he was treated with systemic and topical steroids, topical cyclosporine ophthalmic drops, erythromycin ophthalmic ointment, and artificial tears. At his 1-week follow-up visit after hospital discharge, the patient had complete resolution of his skin findings and improvement of his ocular and oral mucosal findings. Laboratory workup and imaging studies searching for other potential autoimmune and infectious etiologies showed negative results. CONCLUSIONS: Topical antiinflammatory drops, artificial tears, erythromycin ointment, and systemic steroids were an effective treatment for this bilateral blepharoconjunctivitis and EM-like presentation of SARS-CoV-2.
Assuntos
COVID-19 , Conjuntivite , Eritema Multiforme , Exantema , Masculino , Humanos , Adulto , SARS-CoV-2 , Lubrificantes Oftálmicos , Teste para COVID-19 , Pomadas , COVID-19/complicações , COVID-19/diagnóstico , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/etiologia , Conjuntivite/diagnóstico , Conjuntivite/tratamento farmacológico , Conjuntivite/etiologia , EritromicinaRESUMO
INTRODUCTION: Erythema multiforme (EM) is a reactive mucocutaneous disorder typically initiated by viral infections. Although the management of EM differs according to the clinical course and trigger factor, it is not clear whether antiviral suppressive therapies may be useful in cases related to such infections. Moreover, the treatment is most often based on supportive care directed towards only the symptoms. AIM: To present a clinical case of a child in which antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were used for orofacial manifestations of EM secondary to viral infections. CASE REPORT: A Brazilian 1-year-old boy was admitted to an ICU due to a severe Influenza A H3N2 infection, pneumonia with pleural effusion, and sepsis. About 10 days later, it was noted bleeding lip lesions covered by crusts and bleeding tongue lesions, diagnosed as EM secondary to both H3N2 and herpes simplex virus infections, confirmed by serology tests. A combination of an aPDT session and six PBMT sessions was proposed and resulted in almost complete resolution of the lesion on the 7th day. CONCLUSION: Given the complexity of the present case, the combination of phototherapies seems to be a promising tool for treating acute orofacial mucosal lesions of viruses-induced EM. More studies, however, are needed to reach a definite conclusion.
Assuntos
Eritema Multiforme , Herpes Simples , Fotoquimioterapia , Viroses , Masculino , Humanos , Criança , Lactente , Vírus da Influenza A Subtipo H3N2 , Fotoquimioterapia/métodos , Eritema Multiforme/tratamento farmacológico , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Viroses/complicaçõesRESUMO
Erythema multiforme (EM) is a rare cell-mediated immune response characterized by target or iris patches or plaques that present symmetrically on the extremities. This condition may be associated with pruritus but is usually self-limited and spontaneously resolves within 5 weeks of onset; prodromal symptoms are rare. Several known cases have been linked to vaccination, but many vaccines used in pediatric care have been reported as causative agents of EM. This case study offers an association of EM following administration of the hepatitis A and pneumococcal vaccines.
Assuntos
Eritema Multiforme , Vacinas contra Hepatite A/efeitos adversos , Hepatite A , Vacinas Pneumocócicas/efeitos adversos , Criança , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Hepatite A/complicações , Hepatite A/prevenção & controle , Humanos , Imunidade Celular , Vacinação/efeitos adversosRESUMO
Localised erythema multiforme (LEM) is only reported to occur in humans and not in domestic species. This case report describes the clinical and histopathological features of LEM-like reaction in a dog, confined to a region of clipper burn.
L'érythème polymorphe localisé (LEM) n'est signalé que chez l'homme et non chez les animaux domestiques. Ce cas clinique décrit les caractéristiques cliniques et histopathologiques d'une réaction de type LEM chez un chien, localisé sur une région de brûlure de tondeuse.
El eritema multiforme localizado (LEM) sólo se ha descrito en seres humanos y no en especies domésticas. Este artículo describe un caso de un perro con una lesión confinada a una zona de quemadura por un rasurador cuyas características clínicas e histopatológicas fueron similares a LEM.
O eritema multiforme localizado (EML) é relatado apenas em humanos e não em animais domésticos. Este relato de caso descreve as características clínicas e histopatológicas de uma reação EML-símile em um cão, limitada a uma região de queimadura por lâmina de tosa.
Assuntos
Doenças do Cão , Eritema Multiforme , Animais , Doenças do Cão/diagnóstico , Doenças do Cão/etiologia , Cães , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Eritema Multiforme/veterináriaAssuntos
COVID-19 , Eritema Multiforme , Eritema Multiforme/etiologia , Humanos , RNA Mensageiro , SARS-CoV-2 , VacinaçãoRESUMO
ABSTRACT: The relationship between erythema multiforme (EM) and allergic contact dermatitis (ACD) remains unclear. There have been multiple reports of EM-like lesions occurring in conjunction with or presenting after ACD; however, various definitions and terminologies have been used to denote the patient's diagnosis in these cases. In this systematic review, we summarize the key presenting features of recent cases of EM-like eruptions associated with ACD, as well as diagnostic findings, responsible allergens, treatments, and outcomes. We propose that, whenever possible, these cases should be classified into 2 distinct categories: (1) EM-like ACD and (2) EM after ACD (ACD-induced EM). Because the clinical courses, potential complications, and treatment plans differ between the two, a critical need exists for further characterization and distinguishment of EM-like ACD and ACD-induced EM.
Assuntos
Dermatite Alérgica de Contato , Eritema Multiforme , Exantema , Alérgenos/efeitos adversos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Dermatite Alérgica de Contato/patologia , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , HumanosRESUMO
Erythema multiforme is an immune-mediated mucocutaneous disorder. Mucosal involvement usually affects the oral region, the genitals or the eyes. We report a case of esophagitis caused by erythema multiforme in a patient diagnosed with lung cancer. Esophageal manifestation in erythema multiforme is rarely seen. Besides esophagitis it can lead to esophageal strictures. Erythema multiforme is mostly triggered by infection or drugs but the association with malignancy has been described.
Assuntos
Eritema Multiforme , Estenose Esofágica , Esofagite , Neoplasias Pulmonares , Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Esofagite/complicações , Esofagite/diagnóstico , HumanosRESUMO
Rowell Syndrome is a rare presentation of lupus erythematosus manifesting as an eruption of erythema multiforme-like papules and plaques with immunological findings of positive rheumatoid factor, speckled antinuclear antibodies, and/or anti-Ro/La antibodies. This case highlights the unusual and highly debated presentation of Rowell Syndrome in a 66-year-old woman with newly-appearing erythematous, targetoid plaques in the setting of previously diagnosed systemic lupus erythematosus. Skin biopsy revealed histological features of full-thickness epidermal necrosis with focal sub-epidermal separation and a superficial perivascular lymphocytic infiltrate interpreted to favor Rowell Syndrome given her clinical history and presentation. Although no standard treatment exists, a prednisone taper and topical corticosteroids proved effective initially, with complete resolution at six months on mycophenolate mofetil and belimumab.