Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Dec 31;13(12):e20854.
doi: 10.7759/cureus.20854. eCollection 2021 Dec.

Dermatologic and Ophthalmologic Treatment of Erythema Multiforme Major: A Case Report

Barbara Senger  1 , Shayan A Memar  2 , Alex Ahmann  2 , Jeremy J Houser  2 , Lauren Doughty-McDonald  3
Affiliations
Case Reports

Dermatologic and Ophthalmologic Treatment of Erythema Multiforme Major: A Case Report

Barbara Senger et al. Cureus. .

Abstract

Erythema multiforme major (EMM) is a rare type IV cytotoxic reaction targeting keratinocytes of the mucosal surfaces and the dermis. Dusky, targetoid lesions with central clearing are classically present, which may become blistered and rupture. The disease is usually self-limited and managed with supportive care and treatment of the underlying condition. The most common triggering factors are adverse reactions to medications, herpes simplex virus (HSV), and Mycoplasma pneumoniae. Rapid recognition of EMM is essential to avoid long-term complications. This case presents a 39-year-old male with a unique history of recent non-steroidal anti-inflammatory drug (NSAID) use, past infection with HSV-1, and an acute Mycoplasma pneumoniae infection. The patient developed painful lesions on the skin, oral mucosa, ocular surfaces, and urethra. The painful lesions caused complications with feeding and voiding. Initially, the triggering event was unclear. Supportive care was started. NSAIDs were discontinued and similarly-structured drugs were avoided. Treatments targeting Mycoplasma pneumoniae and HSV-1 were initiated while lab results were pending. Once the results returned, the treatment regimen of corticosteroids for inflammation, acyclovir for HSV-1, and azithromycin for Mycoplasma pneumoniae was continued. Vaseline was applied to open lesions. The patient was also treated with mouthwash consisting of aluminum (Al) hydroxide/magnesium (Mg) hydroxide/simethicone (400 mg/400 mg/40 mg). Topical 2% lidocaine gel with applicator was used to assist with urinary discomfort during voiding. Fentanyl was used for pain control. The patient successfully recovered and was discharged to follow-up with ophthalmology. Long-term sequelae including trichiasis, symblepharon, and punctal stenosis were noted during follow-up appointments.

Keywords: erythema multiforme major; hsv-1; mycoplasma pneumonia; nsaids; ocular complications.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Numerous targetoid EMM lesions spread diffusely on the back.
EMM: erythema multiforme major
Figure 2
Figure 2. Bilateral conjunctivitis with injected sclera secondary to EMM.
EMM: erythema multiforme major
Figure 3
Figure 3. Sloughing of oral labia secondary to EMM.
EMM: erythema multiforme major
Figure 4
Figure 4. Cutaneous lesions on the plantar surfaces secondary to EMM.
EMM: erythema multiforme major
See this image and copyright information in PMC

References

    1. Erythema multiforme: diagnosis, clinical manifestations and treatment in a retrospective study of 22 patients. Sanchis JM, Bagán JV, Gavaldá C, Murillo J, Diaz JM. J Oral Pathol Med. 2010;39:747–752. - PubMed
    1. Erythema multiforme: recognition and management. Trayes KP, Love G, Studdiford JS. https://pubmed.ncbi.nlm.nih.gov/31305041/ Am Fam Physician. 2019;100:82–88. - PubMed
    1. The ophthalmologist's role in the management of acute stevens-johnson syndrome and toxic epidermal necrolysis. Fu Y, Gregory DG, Sippel KC, Bouchard CS, Tseng SC. Ocul Surf. 2010;8:193–203. - PubMed
    1. Management of erythema multiforme associated with recurrent herpes infection: a case report. Osterne RL, Brito RG, Pacheco IA, Alves AP, Sousa BF. http://www.cda-adc.ca/jcda/vol-75/issue-8/597.html. J Can Dent Assoc. 2009;75:597–601. - PubMed
    1. James WD, Elston D, Treat JR, Rosenbach MA, Micheletti RG, Neuhaus IM. Amsterdam, Netherlands: Elsevier; 2020. Andrews’ Diseases of the Skin: Clinical Dermatology.

Publication types

LinkOut - more resources