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3.
Ugeskr Laeger ; 181(43)2019 Oct 21.
Artigo em Dinamarquês | MEDLINE | ID: mdl-31617477

RESUMO

Stevens-Johnson syndrome is an autoimmune condition characterised by erythematous target lesions on the skin with involvement of the oral and genital mucosa and conjunctivae. Recent case reports describe incomplete presentations with absence of the characteristic skin changes. This is caused by extrapulmonary manifestations of Mycoplasma pneumoniae lung infection and is now recognised as M. pneumoniae-associated mucositis (MPAM). This case report describes the clinical presentation of MPAM in a 17-year-old girl and highlights the importance of the recognition and the appropriate clinical management.


Assuntos
Eritema Multiforme , Mucosite , Pneumonia por Mycoplasma , Adolescente , Eritema Multiforme/etiologia , Feminino , Humanos , Mucosite/etiologia , Mycoplasma pneumoniae , Pneumonia por Mycoplasma/complicações
4.
Acta Dermatovenerol Croat ; 27(3): 200-201, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31542069

RESUMO

Dear Editor, Systemic lupus erythematosus (SLE) is a heterogeneous autoimmune disease characterized by diverse patterns of auto-antibody production with multi-organ affectation. Cutaneous involvement, either alone or in association with other systemic illnesses, is one of its most common manifestations (1). Dermatologic disorders like malar and discoid rashes are quite suggestive of SLE. However, the occurrence of non-specific skin lesions like erythema multiforme (EM) in patients with SLE (Rowell syndrome) can rarely occur (1). In such patients, a diagnosis of SLE may be missed or delayed in the absence of other overt clinical features of lupus. Herein we report a case of recurring EM-like eruptions as the cardinal cutaneous manifestation of previously undiagnosed, active SLE in a young Nigerian woman. A 26-year-old Nigerian woman presented with a three-day history of non-pruritic, generalized, and target-like, erythematous annular patches and plaques which mostly affected the trunk. A few lesions had presented with crusting and erosions at the time of examination (Figure 1). Associated symptoms included oral painful ulcers, low grade fever, and malaise. The patient had no other systemic symptoms and her prior drug history was not remarkable. Her erythrocyte sedimentation rate (ESR) was 66 mm/hour using the Westergren method. Screening for HIV and hepatitis B and C was negative. Herpes simplex, cytomegalovirus, and Epstein Barr viruses could not be screened for. Other baseline investigations (complete blood count, electrolytes, urea and creatinine as well as urinalysis) were within normal limits. The patient was managed as a case of EM of an unidentified inciting agent and her symptoms resolved with supportive care and antibiotics. However, she developed a recurrence about 5 weeks later, with more extensive and coalescent skin lesions (Figure 2). Additionally, there was a new onset of alopecia and pain in the small joints of the hands as well as both knees and ankles. At this time, the patient's ESR had gone up to 112 mm/h and she had developed significant proteinuria, with a protein creatinine ratio of 1.3 g/g (reference <0.5 g/g). Her antinuclear antibody (ANA) titer was high (1:320) with a speckled pattern. Anti-Smith antibody was also positive. A renal biopsy was declined. A tentative diagnosis of Rowell syndrome was made. The patient was started on high-dose steroids and hydroxychloroquine 200 mg twice daily. Subsequent care included the use of mycophenolate mofetil 1 g twice daily for 6 months. This was then changed to azathioprine at 50 mg twice daily. Follow-up after 6 months showed sustained clearance of skin lesions, resolution of fever and joint pains, as well as improvement in the renal profile, with a urine protein-creatinine ratio of 0.77 g/g. The presence of systemic lupus erythematosus, EM-like lesions, and a speckled pattern of antinuclear antibody in our patient fulfils the revised diagnostic criteria for RS put forward by Zeitouni et al. at the turn of the twenty-first century (2). Considering the rarity of EM-like lesions in SLE and the possibility of constitutional symptoms in EM, a diagnosis of RS may be readily overlooked in patients like the one described, whose major cutaneous manifestation of severe active SLE was EM-like lesions. In contrast to classic EM, where skin lesions are concentrated in the extremities, a predominant truncal distribution of EM-like lesions as found in our patient may favor a clinical consideration of RS (3). However, some authors have challenged the existence of Rowell syndrome as a distinct clinical laboratory entity. Arguments put forward in this regard include the fact that none of the immunological markers that have been described in RS are specific to any disorder. Additionally, the annular polycyclic dermatosis seen in sub-acute cutaneous lupus erythematosus (SCLE) can be difficult to clinically and histologically differentiate from EM (4,5). Patients with SLE also have a higher likelihood of developing adverse drug reactions (6). The inherent complexity of SLE may make for delayed and oftentimes difficult diagnosis, especially in a country where immunologic tests are expensive and rheumatologists are scarce. When patients do occasionally present with recurrences of skin lesions in the spectrum of EM, Steven-Johnson syndrome, and toxic epidermal necrolysis in the absence of a definite inciting agent, undiagnosed lupus may indeed be present in some of these individuals and should be considered in the differential diagnosis. In conclusion, while it is very rare, SLE may present first with recurrent episodes of EM-like rash. Despite the various possibilities which underlie their association, prompt identification and treatment of SLE in patients presenting with EM is important to prevent death or irreversible organ damage.


Assuntos
Eritema Multiforme/diagnóstico , Eritema Multiforme/etiologia , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/diagnóstico , Adulto , Feminino , Humanos , Nigéria
5.
BMJ Case Rep ; 12(8)2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31409617

RESUMO

A 69-year-old man with esophageal EBV-positive diffuse large B cell lymphoma status post allogeneic bone marrow transplant (BMT) five months prior presented to his oncologist with three days of maculopapular rash that was initially diagnosed as grade 1 graft-versus-host disease and started on oral prednisone. However, due to worsening of the rash, the patient presented to dermatology clinic, where skin biopsy revealed a diagnosis of erythema multiforme (EM). The patient improved with the use of topical steroids. This case highlights the atypical morphology of post-BMT EM and the potential causes for this atypical appearance.


Assuntos
Transplante de Medula Óssea/efeitos adversos , Eritema Multiforme/etiologia , Exantema/etiologia , Linfoma de Células B/terapia , Idoso , Humanos , Masculino
6.
Am Fam Physician ; 100(2): 82-88, 2019 07 15.
Artigo em Inglês | MEDLINE | ID: mdl-31305041

RESUMO

Erythema multiforme is an immune-mediated reaction that involves the skin and sometimes the mucosa. Classically described as target-like, the erythema multiforme lesions can be isolated, recurrent, or persistent. Most commonly, the lesions of erythema multiforme present symmetrically on the extremities (especially on extensor surfaces) and spread centripetally. Infections, especially herpes simplex virus and Mycoplasma pneumoniae, and medications constitute most of the causes of erythema multiforme; immunizations and autoimmune diseases have also been linked to erythema multiforme. Erythema multiforme can be differentiated from urticaria by the duration of individual lesions. Erythema multiforme lesions are typically fixed for a minimum of seven days, whereas individual urticarial lesions often resolve within one day. Erythema multiforme can be confused with the more serious condition, Stevens-Johnson syndrome; however, Stevens-Johnson syndrome usually contains widespread erythematous or purpuric macules with blisters. The management of erythema multiforme involves symptomatic treatment with topical steroids or antihistamines and treating the underlying etiology, if known. Recurrent erythema multiforme associated with the herpes simplex virus should be treated with prophylactic antiviral therapy. Severe mucosal erythema multiforme can require hospitalization for intravenous fluids and repletion of electrolytes.


Assuntos
Eritema Multiforme/diagnóstico , Eritema Multiforme/terapia , Eritema Multiforme/etiologia , Humanos
7.
J Am Acad Dermatol ; 81(3): 813-822, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331726

RESUMO

BACKGROUND: Erythema multiforme (EM) is an acute inflammatory mucocutaneous condition. EM is rarely described in children and infants. OBJECTIVE: To investigate the triggers, clinical manifestations, and treatment of pediatric EM. METHODS: Systematic literature review of pediatric EM. RESULTS: After full-text article review, we included 113 articles, representing 580 patients. The mean age was 5.6 years, ranging 0.1-17 years. Infectious agents were the main triggers: herpes simplex virus (HSV) in 104 patients (17.9%) and Mycoplasma pneumoniae in 91 patients (15.7%). In total, 140 cases (24.1%) were drug-related and 89 cases (15.3%) had other triggers, such as vaccines (19 patients, 3.2%). In total, 229 patients had EM major (39.5%). Treatment was supportive care only (180 patients, 31.1%), systemic corticosteroids (115 patients, 19.8%), antivirals (85 patients, 14.6%), and antibiotics (66 patients, 11.3%), mostly macrolides (45 patients, 7.7%). Long-term sequelae were rare (1.3%). Pediatric EM was reported in 19 infants (3.2%). The main trigger was vaccination (9 patients). Infantile EM was EM major in 2 cases and EM minor in 17. Infants were less prone to develop EM major than older children (P < .01). Pediatric EM was recurrent in 83 cases (14.3%), which was triggered by HSV in 36 patients (61%). Recurrence affected older children. LIMITATIONS: Potential confusion between Steven Johnson syndrome and EM major in addition to publication bias. CONCLUSION: Pediatric EM is a rare disease, mainly triggered by infections. This condition can affect all mucosal surfaces, most commonly the oral mucosae. The diagnosis is clinical, and management relies on supportive care. Vaccines are a particular trigger in infants. Recurrent cases are most commonly linked to HSV. Dermatologists and pediatricians should be aware of this potentially recurrent and severe condition.


Assuntos
Eritema Multiforme/etiologia , Cuidados Paliativos/métodos , Doenças Raras/etiologia , Vacinação/efeitos adversos , Adolescente , Fatores Etários , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Criança , Pré-Escolar , Diagnóstico Diferencial , Erupção por Droga/diagnóstico , Erupção por Droga/etiologia , Erupção por Droga/terapia , Eritema Multiforme/diagnóstico , Eritema Multiforme/terapia , Glucocorticoides/uso terapêutico , Herpes Simples/complicações , Herpes Simples/tratamento farmacológico , Humanos , Lactente , Mucosa Bucal/microbiologia , Mucosa Bucal/patologia , Pneumonia por Mycoplasma/complicações , Pneumonia por Mycoplasma/tratamento farmacológico , Doenças Raras/diagnóstico , Doenças Raras/terapia , Recidiva , Índice de Gravidade de Doença
8.
BMJ Case Rep ; 12(5)2019 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-31092494

RESUMO

Erythema multiforme is a skin disorder characterised by target epithelial eruption, which is mainly caused by infection or drugs. In this case, we report an erythema multiforme like reaction caused by contact dermatitis against wood, especially santos rosewood. During the hospitalisation, we performed a patch test with lumber used in the patient's workplace, and recognised a positive response to multiple woods and a simultaneous recurring eruption (flare up) outside of the test site. The findings from this case of contact dermatitis caused by frequently used industrial wood type is important for the management of occupational environments. A review of the literature on erythema multiforme like reaction due to contact dermatitis, including past case reports, has also been provided.


Assuntos
Eritema Multiforme/etiologia , Doenças Profissionais/etiologia , Madeira/efeitos adversos , Administração Cutânea , Adulto , Clobetasol/administração & dosagem , Dermatite Alérgica de Contato , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Fabaceae/efeitos adversos , Humanos , Masculino , Doenças Profissionais/diagnóstico , Doenças Profissionais/tratamento farmacológico , Testes do Emplastro , Taxaceae/efeitos adversos
11.
J Assoc Physicians India ; 66(1): 98-9, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-30341854

RESUMO

A 22 year old male Indian patient presented with high grade fever, multiple joint pain, low back pain, generalized body ache since 6 months and erythematous pruritic rashes and atypical annular target like lesions over face, arm, leg and back and ulcers on hard palate and buccal mucosa for 2 months. Laboratory investigations showed a speckled pattern anti-nuclear antibody with a titer >1:160 and positive SS-A, dsDNA auto-antibodies and Rheumatoid factor. Diagnosis of Rowell's syndrome was made based on clinical and laboratory finding and the patient was treated with oral prednisolone (50 mg/day), hydroxychloroquine (200 mg q12h) and pulse cyclophosphamide (700 mg) chemotherapy. Majority of skin lesions and oral ulcerations subsided after 4 weeks of therapy. Till date only 11 male patients out of the total 71 cases of Rowell's syndrome were reported in the world's literature.


Assuntos
Eritema Multiforme/etiologia , Lúpus Eritematoso Sistêmico/diagnóstico , Anticorpos Antinucleares/sangue , Humanos , Masculino , Adulto Jovem
15.
Pediatr Dermatol ; 35(4): e237-e238, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29766553

RESUMO

The case of a 6-year-old boy with multiple, target-shaped lesions and a crusted nodule on his right index finger is presented. Based on clinical findings and the patient's recent contact with sheep and goats, a diagnosis of orf disease associated with erythema multiforme was suspected. Microscopy studies confirmed the presence of parapoxvirus in the primary lesion. Orf-induced erythema multiforme is a rare complication of orf in children, possibly related to the presence of orf virus DNA in erythema multiforme lesions.


Assuntos
Ectima Contagioso/complicações , Eritema Multiforme/etiologia , Vírus do Orf/isolamento & purificação , Criança , Ectima Contagioso/diagnóstico , Eritema Multiforme/diagnóstico , Humanos , Masculino , Remissão Espontânea , Pele/patologia
16.
Autoimmun Rev ; 17(6): 576-581, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29635075

RESUMO

Scientific and clinical data indicate that human herpes simplex virus 1 (HSV1) and, at a lesser extent, human herpes simplex virus 2 (HSV2) are factor(s) implicated in the development of erythema multiforme (EM). With a focus on oral EM, the present structured review of proteomic and epitope databases searched for the molecular basis that might link HSV1 and HSV2 infections to EM. It was found that a high number of peptides are shared between the two HSVs and human proteins related to the oral mucosa. Moreover, a great number of the shared peptides are also present in epitopes that have been experimentally validated as immunopositive in the human host. The results suggest the involvement of HSV infections in the induction of oral EM via a mechanism of autoimmune cross-reactivity and, in particular, highlight a potential major role for 180kDa bullous pemphigoid antigen and HSV1 infection in the genesis of crossreactions potentially conducive to EM.


Assuntos
Eritema Multiforme/etiologia , Herpes Simples/complicações , Herpes Simples/imunologia , Simplexvirus/imunologia , Anticorpos Antivirais/efeitos adversos , Anticorpos Antivirais/imunologia , Reações Cruzadas , Epitopos , Eritema Multiforme/imunologia , Humanos , Mucosa Bucal/imunologia , Proteômica
17.
Pediatr Dermatol ; 35(4): 478-481, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29582465

RESUMO

Tularemia is a rare and potentially life-threatening infection caused by the highly infectious gram-negative coccobacillus Francisella tularensis. We present the case of an 11-year old girl who presented with erythema multiforme minor in the setting of an indolent but progressive soft tissue infection and was found to have tularemia. We review the role of dermatologists in identifying the features of and complications associated with this rare zoonosis and discuss the potential effect of climate change on its incidence.


Assuntos
Eritema Multiforme/etiologia , Doenças Transmitidas por Carrapatos/complicações , Tularemia/complicações , Antibacterianos/uso terapêutico , Criança , Feminino , Francisella tularensis/isolamento & purificação , Humanos , Doenças Transmitidas por Carrapatos/diagnóstico , Tularemia/diagnóstico , Tularemia/tratamento farmacológico
18.
Dermatol Online J ; 24(1)2018 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-29469759

RESUMO

BACKGROUND: Erythema multiforme (EM), Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are cutaneous hypersensitivityreactions that develop in response to specific triggers such as medications and certain infections. Vaccines, which undergo rigorous safety testing prior to use in humans, are a rare cause of SJS/TEN and little is known about the frequency of such events and corresponding pathogenesis. OBJECTIVE: Herein, we discuss a case of suspected TEN in a 19-year-old woman who received the meningococcal B vaccine (the first report of such an association) and conduct a systematic review of the associated literature. We also discuss management of this patient with a single dose of etanercept. METHODS: Relevant literature was searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS: A total of 29 articles reporting EM, SJS, or TEN following vaccination were included from >5 countries. Of the 29, 22 articles reported EM, 6/29 reported SJS, and 4/29 reported TEN (3 articlesreported cases of both EM and SJS/TEN). CONCLUSIONS: We suggest consideration of vaccines as an etiology for cases of SJS or TEN that begin with an EM-like presentation, and provide further evidence for the use of etanercept as a viable treatment for TEN.


Assuntos
Vacinas Meningocócicas/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Adulto , Criança , Eritema Multiforme/etiologia , Feminino , Humanos , Lactente , Masculino , Neisseria meningitidis Sorogrupo B , Pele/patologia , Síndrome de Stevens-Johnson/patologia , Adulto Jovem
20.
Int J STD AIDS ; 29(1): 99-102, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28820345

RESUMO

We are currently facing a worldwide epidemic of syphilis. Clinical manifestations that are rarely seen have been encountered, leading the dermatologist to confront unusual clinical conditions in daily practice. Erythema multiforme triggered by syphilis is very rare and is also seldom reported in the literature. We report a case of secondary syphilis in an HIV-positive patient, whose clinical, pathologic and serologic features were consistent with the diagnosis of erythema multiforme triggered by syphilis.


Assuntos
Eritema Multiforme/etiologia , Infecções por HIV/complicações , Sífilis/diagnóstico , Treponema pallidum/isolamento & purificação , Adulto , Antibacterianos/uso terapêutico , Biópsia , Eritema Multiforme/complicações , Eritema Multiforme/diagnóstico , Eritema Multiforme/tratamento farmacológico , Humanos , Penicilina G/uso terapêutico
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