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Mori N, Fidanzi C, Bevilacqua M, Ciccarese G, D'Erme AM, Janowska A. Cemiplimab-Induced Erythema Multiforme in a Patient with Metastatic Squamous Cell Carcinoma of the Penis. Dermatitis 2024. [PMID: 39101241 DOI: 10.1089/derm.2024.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Affiliation(s)
- Nicolò Mori
- Unit of Dermatology, Department of Medical and Oncology Area, University of Pisa, Pisa, Italy
| | - Cristian Fidanzi
- Unit of Dermatology, Department of Medical and Oncology Area, University of Pisa, Pisa, Italy
- Melanoma and Skin Cancer Unit AVNO (Area Vasta Nord Ovest) Toscana, New Apuan Hospital, Pisa, Italy
| | - Matteo Bevilacqua
- Unit of Dermatology, Department of Medical and Oncology Area, University of Pisa, Pisa, Italy
| | - Giulia Ciccarese
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | - Agata Janowska
- Unit of Dermatology, Department of Medical and Oncology Area, University of Pisa, Pisa, Italy
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Benammou S, Galvadon M, Hanslik T, Duong TA, Bourgeois C, Salle R. [Isolated erosive mucositis]. Rev Med Interne 2024; 45:447-449. [PMID: 38719670 DOI: 10.1016/j.revmed.2024.04.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/14/2024] [Indexed: 07/14/2024]
Affiliation(s)
- S Benammou
- Service de dermatologie générale et oncologique, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - M Galvadon
- Maison médicale pluridisciplinaire, Ma maison médicale, 14, rue Preschez, 92210 Saint-Cloud, France
| | - T Hanslik
- Service de médecine interne, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - T-A Duong
- Service de dermatologie générale et oncologique, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Bourgeois
- Maison médicale pluridisciplinaire, Ma maison médicale, 14, rue Preschez, 92210 Saint-Cloud, France
| | - R Salle
- Service de dermatologie générale et oncologique, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
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Santo ANT, Hidayat W, Dewi TS. Vaping as a Risk Factor for Oral Erythema Multiforme: A Case Report and Literature Review. Int Med Case Rep J 2024; 17:535-543. [PMID: 38828364 PMCID: PMC11144004 DOI: 10.2147/imcrj.s455640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Abstract
Introduction Erythema multiforme is a hypersensitivity reaction caused by various factors, such as viruses, chemicals, and drugs. Electronic cigarettes (e-cigarettes) or vape is a battery-powered nicotine delivery device that substitutes for traditional cigarettes. The chemical components of vaping, including propylene glycol and nicotine, can cause hypersensitivity reactions. Objective To report a case of oral erythema multiforme in an e-cigarettes user, treatment, and review the literature regarding the impact of these devices on oral health. Clinical Case A 22-year-old woman came to the Oral Medicine Department with complaints of stomatitis causing pain, eating, and drinking difficulty, which started with fever and pimple-like on the lips. She was an active vape user for one year. Extraoral examination revealed no lesions on other body parts. The serosanguinolent crusts on the lips, an erosive area on the labial commissures and tended to bleed. Intraoral examination revealed white ulcers with yellowish edges and irregular, varying sizes in several parts of the oral mucosa. The anti-HSV-1 IgG laboratory results showed non-reactive, leading to a diagnosis of oral erythema multiforme. Management of oral conditions using 0.9% NaCl compress, dexamethasone mouthwash, and hyaluronic acid, applying 2% miconazole cream on labial commissures and vaseline album cream on the dry lips, and stopping vaping. Oral condition improved in a week of therapy. Conclusion Erythema multiforme restricted to the mouth is rare, especially associated with electronic cigarettes. Early identification of oral ulcerative disorders is crucial for accurate diagnosis and treatment, where clinicians should consider oral erythema multiforme as a possible diagnosis.
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Affiliation(s)
| | - Wahyu Hidayat
- Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
| | - Tenny Setiani Dewi
- Department of Oral Medicine, Faculty of Dentistry, Padjadjaran University, Bandung, Indonesia
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Manenzhe SC, Khammissa RAG, Shangase SL, Beetge MM. Exploring the association between erythema multiforme and HIV infection: some mechanisms and implications. AIDS Res Ther 2024; 21:24. [PMID: 38637892 PMCID: PMC11027329 DOI: 10.1186/s12981-024-00607-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
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.
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Affiliation(s)
- Shumani Charlotte Manenzhe
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa
| | - Razia Abdool Gafaar Khammissa
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa.
| | | | - Mia Michaela Beetge
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Pretoria, PO Box 1266, Pretoria, 0001, South Africa
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5
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Saleh W, Alharbi H, Cha S. Increased prevalence of erythema multiforme in patients with COVID-19 infection or vaccination. Sci Rep 2024; 14:2801. [PMID: 38307870 PMCID: PMC10837137 DOI: 10.1038/s41598-024-52099-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/13/2024] [Indexed: 02/04/2024] Open
Abstract
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.
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Affiliation(s)
- Wafaa Saleh
- Oral Medicine, Periodontology, Diagnosis and Oral Radiology Department, Faculty of Dentistry, Mansoura University, Mansoura, 33516, Egypt.
| | - Hamad Alharbi
- Department of Oral and Maxillofacial Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Seunghee Cha
- Oral and Maxillofacial Diagnostic Sciences, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
- Center for Orphaned Autoimmune Disorders (COAD), University of Florida College of Dentistry, Gainesville, FL, 32610, USA
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Pipitò L, Cascio A. Acute Cytomegalovirus Infection Associated With Erythema Multiforme-Like Eruption: A Case Report. Cureus 2024; 16:e54540. [PMID: 38516453 PMCID: PMC10956636 DOI: 10.7759/cureus.54540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Human cytomegalovirus infection usually proceeds asymptomatically in immunocompetent patients. In symptomatic forms, mononucleosis syndrome is the most common manifestation. However, atypical cases of cytomegalovirus infections in immunocompetent subjects are reported in the literature. Here, we describe a case of cytomegalovirus-related mononucleosis syndrome that presented with an atypical erythema multiforme-like skin rash and high fever. Very few cases have been described in the literature previously. In our case, the diagnosis was supported by specific serology, and human cytomegalovirus DNA was detected in the blood sample. The clinical picture resolved without the administration of antiviral therapy.
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Affiliation(s)
- Luca Pipitò
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, "G D'Alessandro, University of Palermo, AOUP P. Giaccone, Palermo, ITA
| | - Antonio Cascio
- Infectious and Tropical Diseases Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, "G D'Alessandro, University of Palermo, AOUP P. Giaccone, Palermo, ITA
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7
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Ingen-Housz-Oro S, Joly P, Kini-Matondo W, Sbidian E. Prevention of recurrent erythema multiforme with lenalidomide: a case series. Clin Exp Dermatol 2024; 49:166-168. [PMID: 37683088 DOI: 10.1093/ced/llad314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/02/2023] [Accepted: 09/21/2023] [Indexed: 09/10/2023]
Abstract
Prevention of recurrences of erythema multiforme is a therapeutic challenge. Thalidomide is effective, but its use is limited by adverse effects, especially peripheral neuropathy. We report seven cases of recurrent severe erythema multiforme treated with lenalidomide. In six cases, the drug was effective without significant adverse effects.
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Affiliation(s)
- Saskia Ingen-Housz-Oro
- Dermatology Department
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions (TOXIBUL), Créteil, France
- University Paris Est Créteil Val de Marne EpiDermE, Créteil, France
| | - Pascal Joly
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions (TOXIBUL), Créteil, France
- Dermatology Department, Charles Nicolle University Hospital, Rouen, France
| | | | - Emilie Sbidian
- Dermatology Department
- Reference Center for Toxic Bullous Diseases and Severe Drug Reactions (TOXIBUL), Créteil, France
- University Paris Est Créteil Val de Marne EpiDermE, Créteil, France
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Demouche S, Bettuzzi T, Sbidian E, Laugier Castellan D, Osmont MN, Ingen-Housz-Oro S, Lebrun-Vignes B. Reality of drug-induced erythema multiforme: A French pharmacovigilance study. Therapie 2023; 78:711-719. [PMID: 37024401 DOI: 10.1016/j.therap.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Since the 2002 SCAR study, erythema multiforme (EM), a post-infectious disease, has been distinguished from Stevens-Johnson syndrome (SJS), drug-induced. Nevertheless, EM cases are still reported in the French pharmacovigilance database (FPDB). OBJECTIVES To describe EM reported in the FPDB and to compare the quality and the characteristics of the reports. METHODS This retrospective observational study selected all EM cases reported in the FPDB over two periods: period 1 (P1, 2008-2009) and period 2 (P2, 2018-2019). Inclusion criteria were 1) a diagnosis of clinically typical EM and/or validated by a dermatologist; 2) a reported date of onset of the reaction; and 3) a precise chronology of drug exposure. Cases were classified confirmed EM (typical acral target lesions and/or validation by a dermatologist) and possible EM (not-otherwise-specified target lesions, isolated mucosal involvement, doubtful with SJS). We concluded possible drug-induced EM when EM was confirmed, with onset ranging from 5 to 28 days without an alternative cause. RESULTS Among 182 selected reports, 140 (77%) were analyzed. Of these, 67 (48%) presented a more likely alternative diagnosis than EM. Of the 73 reports of EM cases finally included (P1, n=41; P2, n=32), 36 (49%) had a probable non-drug cause and 28 (38%) were associated with only drugs with an onset time ≤4 days and/or ≥29 days. Possible drug-induced EM was retained in 9 cases (6% of evaluable reports). Etiological work-up was more often performed in period 2 than 1 (53.1% vs 29.3%, P=0.04), and the time to onset from 5 to 28 days was more frequent in period 2 (59.2% vs 40%, P=0.04). CONCLUSIONS This study suggests that possible drug-induced EM is rare. Many reports describe "polymorphic" rashes inappropriately concluded as EM or post-infectious EM with unsuitable drug accountability subject to protopathic bias.
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Affiliation(s)
- Sarah Demouche
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Thomas Bettuzzi
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France
| | - Emilie Sbidian
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France
| | - Delphine Laugier Castellan
- Centre régional de pharmacovigilance Marseille - Provence - Corse, hôpital Sainte-Marguerite, AP-HM, 13005 Marseille, France
| | - Marie-Noelle Osmont
- Centre régional de pharmacovigilance de Rennes, CHRU hôpital Pontchaillou, 35000 Rennes, France
| | - Saskia Ingen-Housz-Oro
- Service de dermatologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France; Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France; Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, 94000 Créteil, France.
| | - Bénédicte Lebrun-Vignes
- Université Paris-Est Créteil, EpiDermE, 94000 Créteil, France; Reference center for toxic bullous diseases and severe drug reactions TOXIBUL, 94000 Créteil, France; Centre régional de Pharmacovigilance - hôpital Pitié-Salpêtrière GH, Sorbonne université, AP-HP, 75000 Paris, France
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9
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Rykiel K, Melchor J, Motie I, Mulles K, Farhangi V. Recurrent Erythema Multiforme Major Following COVID-19 Infection. Cureus 2023; 15:e42646. [PMID: 37644930 PMCID: PMC10461501 DOI: 10.7759/cureus.42646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 08/31/2023] Open
Abstract
Erythema multiforme (EM) is a rare and potentially serious skin condition that can present as a myriad of mucocutaneous lesions. EM can be commonly confused with other cutaneous etiologies, leading to misdiagnosis and delay in proper treatment. This paper describes a case of recurrent erythema multiforme following COVID-19 infection in a 34-year-old male with no prior medical history. The patient had an extensive rash of the oral and genital mucosal areas, diffuse cutaneous involvement, and an extended length of recovery. This unexpected association of EM and COVID-19 provides additional insight into the limited research available regarding the correlation between these two pathologies.
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Affiliation(s)
- Kayla Rykiel
- Medicine, Florida State University College of Medicine, Tallahassee, USA
| | - Julian Melchor
- Medicine, Florida State University College of Medicine, Tallahassee, USA
| | - Ian Motie
- Internal Medicine, Florida State University School of Medicine, Sarasota Memorial Hospital, Sarasota, USA
| | - Kevin Mulles
- Internal Medicine, Florida State University School of Medicine, Sarasota Memorial Hospital, Sarasota, USA
| | - Vida Farhangi
- Internal Medicine, Florida State University School of Medicine, Sarasota Memorial Hospital, Sarasota, USA
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Aswath N, Rakshana R, Rakshana R. Drug induced erythema multiforme of the oral cavity. Arch Clin Cases 2022; 9:157-160. [PMID: 36628160 PMCID: PMC9769071 DOI: 10.22551/2022.37.0904.10224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Drug induced erythema multiforme (EM) is a rare clinical entity which majorly involves the oral cavity. It commonly occurs due to intake of drugs such as NSAID'S, certain antibiotics, and anticonvulsants. It is characterized by rapidly rupturing vesicles leading to ill-defined erosions in the oral cavity and encrusted lip lesions. These lesions are usually difficult to differentiate from other vesiculo bullous and ulcerative lesions which would have a similar presentation and the absence of skin lesions can sometimes lead to misdiagnosis. Drug induced EM has an acute onset and is a self-limiting inflammatory hypersensitivity reaction that causes blistering and ulcerations of the skin and mucous membrane. The lesions heal following the discontinuation of the causative medications. This case report describes a case of drug induced erythema multiforme of the oral cavity that occurred consequent to the intake of Tab.Diclofenac Sodium and Tab.Cephelexin. The patient developed painful, bleeding, burning ulcerations with severe crustations on the upper, and lower lip, lateral and ventral surface of tongue, hard palate and retro molar regions. The case was managed with corticosteroids.
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Affiliation(s)
- Nalini Aswath
- Correspondence: Nalini Aswath, Department of Oral Medicine & Radiology, Sree Balaji Dental College & Hospital, Bharath Institute of Higher Education & Research, Velachery Rd, VGP Rajesh Nagar, Pallikaranai, Chennai, Tamil Nadu 600100, India.
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Vrana E, Mylona S, Bobos M, Kontovinis L, Papazisis K. Ribociclib and palbociclib-induced erythema multiforme: a case report. Oxf Med Case Reports 2022; 2022:omac116. [PMID: 36447465 PMCID: PMC9693799 DOI: 10.1093/omcr/omac116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 12/07/2023] Open
Abstract
Cyclin-dependent kinase 4/6 inhibitors (CKIs), ribociclib, palbocilb and abemaciclib, have been approved in combination with endocrine therapy for the treatment of hormone receptor-positive and human epidermal growth factor 2-negative advanced or metastatic breast cancer. Severe dermatological adverse events are rare with these agents; however, they require direct recognition and management in order not to become life-threatening. Erythema multiforme (EM) belongs to a dermatopathic spectrum that includes immune-mediated, widespread hypersensitivity reaction, which occurs with varying degrees of severity and affects the skin and/or the mucosa. We hereby present a case of ribociclib- and palbociclib-related EM. We sought to report this case given the implication of two agents from the same drug class in EM onset. We also aim to emphasize the breadth of mechanisms of actions of CKIs, with an impingement in the immune system as well, and the importance of promptly identifying and handling such skin toxicities.
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Affiliation(s)
- Eleni Vrana
- “Euromedica” General Clinic, Oncology Department, 54645 Thessaloniki, Greece
| | | | | | - Loukas Kontovinis
- “Euromedica” General Clinic, Oncology Department, 54645 Thessaloniki, Greece
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12
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Mohseni Afshar Z, Tavakoli Pirzaman A, Liang JJ, Sharma A, Pirzadeh M, Babazadeh A, Hashemi E, Deravi N, Abdi S, Allahgholipour A, Hosseinzadeh R, Vaziri Z, Sio TT, Sullman MJM, Barary M, Ebrahimpour S. Do we miss rare adverse events induced by COVID-19 vaccination? Front Med (Lausanne) 2022; 9:933914. [PMID: 36300183 PMCID: PMC9589063 DOI: 10.3389/fmed.2022.933914] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has caused many complications, the invention of coronavirus disease 2019 (COVID-19) vaccines has also brought about several adverse events, from common side effects to unexpected and rare ones. Common vaccine-related adverse reactions manifest locally or systematically following any vaccine, including COVID-19 vaccines. Specific side effects, known as adverse events of particular interest (AESI), are unusual and need more evaluation. Here, we discuss some of the most critical rare adverse events of COVID-19 vaccines.
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Affiliation(s)
- Zeinab Mohseni Afshar
- Clinical Research Development Center, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Jackson J. Liang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Service, University of Michigan, Ann Arbor, MI, United States
| | - Akanksha Sharma
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, United States
| | - Marzieh Pirzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Arefeh Babazadeh
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Erfan Hashemi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Deravi
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sadaf Abdi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Amirreza Allahgholipour
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Hosseinzadeh
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Vaziri
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Terence T. Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, United States
| | - Mark J. M. Sullman
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Mohammad Barary
- Student Research Committee, Virtual School of Medical Education and Management, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Soheil Ebrahimpour
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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Next-generation sequencing-assisted diagnosis of a case of leprosy misdiagnosed as erythema multiforme. Ann Clin Microbiol Antimicrob 2022; 21:40. [PMID: 36071525 PMCID: PMC9454213 DOI: 10.1186/s12941-022-00532-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Leprosy is a chronic infectious disease caused by Mycobacterium leprae or Mycobacterium lepromatosis that is mainly transmitted through droplets from the nose and mouth of untreated patients. Owing to the lack of specific serological markers and clinical manifestations, leprosy can be easily confused with other skin lesion-related diseases and is difficult to distinguish. Case presentation This study introduces and summarises the diagnosis and treatment process of a case of leprosy misdiagnosed as erythema multiforme for a long time. A 43-year-old female was admitted to our hospital because of “repeated fever with superficial lymphadenopathy and systemic rash in May”. The diagnosis of the patient was based on the two main clinical characteristics of superficial lymphadenopathy and systemic pleomorphic erythema by using a combination of multiple samples of lymph nodes and skin, routine pathological examination, immunohistochemistry, acid-fast, silver hexamine, periodic acid-Schiff (PAS) staining, and second-generation gene sequencing of fresh biopsy tissue. The patient was treated with dapsone, rifampicin, and clofazimine at the Institute of Dermatology and Venereal Diseases. After treatment for 1 year, her temperature returned to normal, the area of facial erythema decreased, and the volume of axillary lymph nodes had gradually reduced. Conclusions In conclusion, special pathological staining and second-generation gene sequencing show promising advantages in distinguishing leprosy from other skin lesion-related diseases.
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Abstract
Annular lichenoid diseases encompass a diverse range of pathologies that present as circular, raised, or flat lesions that may vary in size and number. Examples include annular lichenoid dermatitis of youth, annular lichen planus, erythema dyschromicum perstans, erythema multiforme, fixed drug eruption, lichen sclerosus, neonatal lupus, porokeratosis, subacute cutaneous lupus erythematosus, and lichenoid syphilis. Clinical morphology and histopathology can differentiate these entities.
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15
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Caseiro Alves ME, Cordeiro AI, Carvalho R, João A. Atypical presentation of erythema multiforme. BMJ Case Rep 2022; 15:e251076. [PMID: 35793857 PMCID: PMC9260799 DOI: 10.1136/bcr-2022-251076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- M Eduarda Caseiro Alves
- Pediatric Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Ana Isabel Cordeiro
- Primary Immunodeficiencies Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Rodrigo Carvalho
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
| | - Alexandre João
- Department of Dermatology and Venereology, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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16
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Diep D, Aluri B, Crane A, Miao K, Kannan KS, Goldsteen R. Stevens-Johnson Syndrome in a Patient of Color: A Case Report and an Assessment of Diversity in Medical Education Resources. Cureus 2022; 14:e22245. [PMID: 35340465 PMCID: PMC8929762 DOI: 10.7759/cureus.22245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
This is a review of a patient encounter that underscores the common trend of insufficient inclusivity and lack of diversity regarding skin of color representation in teaching materials including textbooks in the medical education setup. A Black woman who was treated with carbamazepine for trigeminal neuralgia after a dental procedure presented with upper airway breathing difficulties and facial pain and swelling. After doubling her dose of carbamazepine as advised by her primary care physician, her symptoms continued to worsen, and she was treated in the emergency department for a presumed allergic reaction of unknown etiology. Two days later, her symptoms progressively worsened. She self-admitted to the emergency department, where she required cardiopulmonary resuscitation. Eventually, the formal diagnosis of carbamazepine-induced Stevens-Johnson syndrome (SJS) was made based on history, clinical presentation, and skin biopsy. The nature of the disease progression in this case prompted our investigation into the lack of representation of skin of color in current medical training resources regarding SJS. Our assessment demonstrates that there is a significant underrepresentation of SJS in skin of color in medical educational resources. Increased inclusivity of skin disorders in patients of color is crucial in training healthcare professionals to recognize life-threatening cutaneous disorders quickly and accurately in such patients.
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17
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Zaouak A, Daldoul M, Chamli A, Frioui R, Khanchel F, Brahim EB, Fenniche S, Hammami H. Cefixime-induced bullous erythema multiforme major. Int J Dermatol 2022; 61:e280-e282. [PMID: 35141882 DOI: 10.1111/ijd.16119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/29/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Anissa Zaouak
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Mouna Daldoul
- Pharmacovigilance Department, University of Medicine of Tunis, Tunis, Tunisia
| | - Amal Chamli
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Refka Frioui
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Fatma Khanchel
- Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Ehsen Ben Brahim
- Anatomopathology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Samy Fenniche
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
| | - Houda Hammami
- Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia
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18
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Pesqué D, Tormo-Mainar S, Bach R, Recuero-Borau J, Pujol RM. Switching PARP inhibitors as an effective approach for niraparib-induced erythema multiforme. Int J Dermatol 2022; 61:e407-e408. [PMID: 35080014 DOI: 10.1111/ijd.16055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/18/2021] [Indexed: 12/01/2022]
Affiliation(s)
- David Pesqué
- Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Sara Tormo-Mainar
- Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Rafael Bach
- Department of Oncology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Jordi Recuero-Borau
- Department of Oncology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ramon M Pujol
- Department of Dermatology, Hospital del Mar- Institut Mar d'Investigacions Mèdiques, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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19
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20
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Guillouet C, Riou MC, Duong LT, de La Dure-Molla M, Fournier BPJ. Oral lesions of viral, bacterial, and fungal diseases in children: A decision tree. Front Pediatr 2022; 10:937808. [PMID: 35958174 PMCID: PMC9358008 DOI: 10.3389/fped.2022.937808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/05/2022] [Indexed: 11/13/2022] Open
Abstract
Oral mucosal lesions are common in the pediatric population and, apart from traumatic and tumoral etiologies, they can be symptoms of viral, bacterial, fungal or parasitic diseases. Yet, pediatricians and pediatric dentists find it challenging to reach a diagnosis and provide appropriate care when facing lesions of the masticatory or lining mucosa, of the hard or soft palate, of the tongue or salivary glands. Here, we propose a decision tree for the diagnosis of the most frequent viral, bacterial, and fungal diseases starting from their oral lesions in children. By first focusing on describing the elementary lesion itself before its localization and characteristics, it aims to guide the practitioner toward the diagnosis and any necessary complementary exams. To generate this tool, we conducted a literature review of the childhood viral, bacterial, fungal and parasitic diseases with oral mucosal symptoms. For each of the 42 reported diagnoses-20 viral, 9 bacterial, 5 fungal, and 8 parasitic-we collected the infection mechanism and agent(s), the oral lesions and their description, the associated systemic signs and the incidence/prevalence. In fine, our decision tree indexes the 28 diseases for which epidemiological data was available, mainly in Europe and the United States.
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Affiliation(s)
- Charlotte Guillouet
- Laboratory of Embryology and Genetics of Human Malformations, INSERM UMR 1163, Institut Imagine, Université Paris Cité, Paris, France.,Université Paris Cité, Dental Faculty, Department of Pediatric Dentistry, Paris, France.,AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France
| | - Margot C Riou
- Université Paris Cité, Dental Faculty, Department of Pediatric Dentistry, Paris, France.,AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France.,Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMRS 1138, Molecular Oral Pathophysiology, Paris, France
| | - Lucas T Duong
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMRS 1138, Molecular Oral Pathophysiology, Paris, France.,AP-HP, Charles Foix Hospital, Oral Surgery Department, Paris, France.,Gustave Roussy, Paris-Saclay University, Department of Head and Neck Surgical Oncology, Villejuif, France
| | - Muriel de La Dure-Molla
- Université Paris Cité, Dental Faculty, Department of Pediatric Dentistry, Paris, France.,AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France.,Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies, INSERM UMR 1163, Institut Imagine, Université Paris Cité, Paris, France
| | - Benjamin P J Fournier
- AP-HP, Rothschild Hospital (ORARES), Dental Department, Reference Center for Oral and Dental Rare Diseases, Paris, France.,Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM UMRS 1138, Molecular Oral Pathophysiology, Paris, France.,Université Paris Cité, Dental Faculty, Department of Oral Biology, Paris, France
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21
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Zhu Q, Wang D, Peng D, Xuan X, Zhang G. Erythema multiforme caused by varicella-zoster virus: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221127657. [PMID: 36189457 PMCID: PMC9516419 DOI: 10.1177/2050313x221127657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Erythema multiforme is a widespread hypersensitivity reaction, its pathogenesis is
related to a variety of factors, including drugs and viral and bacterial infections. It is
true that erythema multiforme is often caused by viruses while current studies suggest
that it is mostly associated with herpes simplex virus infection, rarely associated with
varicella-zoster virus infection. Here, we report a 50-year-old man admitted to our
hospital because of rashes on the left rib with pain for 9 days and on limbs and hands for
2 days. Laboratory data showed that varicella-zoster virus (VZV-DNA) test was negative in
blood by qualitative polymerase chain reaction. Herpes zoster virus IgM (VZV-IgM) enzyme
linked immune sorbent assay was negative, and herpes zoster virus IgG (VZV-IgG) enzyme
linked immune sorbent assay was positive. Herpes zoster and erythema multiforme was
diagnosed. After treatment with antiviral, antiallergic, and topical drugs, the rashes was
significantly improved. Our case report contributes to the pathogenesis of erythema
multiforme.
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Affiliation(s)
- Qing Zhu
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dongxue Wang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dandan Peng
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaomei Xuan
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guoqiang Zhang
- Department of Dermatology, The First Hospital of Hebei Medical University, Shijiazhuang, China
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22
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The Association Between Allergic Contact Dermatitis and Erythema Multiforme: A Systematic Review of the Literature. Dermatitis 2021; 33:308-322. [PMID: 34967766 DOI: 10.1097/der.0000000000000817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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23
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Alamon-Reig F, Castrejón N, Bosch-Amate X. Erythema Multiforme: When targets lead to diagnosis. Sultan Qaboos Univ Med J 2021; 21:666-667. [PMID: 34888094 PMCID: PMC8631222 DOI: 10.18295/squmj.4.2021.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 01/25/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022] Open
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24
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Roux C, Sbidian E, Bouaziz JD, Kottler D, Joly P, Descamps V, Prost C, Samimi M, Seneschal J, Dupin N, Girard C, Paul M, Le Cleach L, Ingen-Housz-Oro S. Evaluation of Thalidomide Treatment of Patients With Chronic Erythema Multiforme: A Multicenter Retrospective Cohort Study. JAMA Dermatol 2021; 157:1472-1476. [PMID: 34757396 DOI: 10.1001/jamadermatol.2021.4083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Importance Erythema multiforme (EM) may become long term, with a recurrent or persistent course. First-line treatment for chronic EM is valaciclovir. There is no consensus for selection of second-line treatment of chronic EM. Objective The aim of this study was to assess the effectiveness of treatment with thalidomide for patients with chronic EM. Design, Setting, and Participants In this retrospective national multicenter cohort study, among 68 French hospital dermatology departments contacted by e-mail, 10 reported having eligible cases. All adults aged 18 years or older under dermatology care for chronic EM (including recurrent and persistent forms) who had received thalidomide between 2010 and 2018 were included. Analyses were conducted from June 24, 2019, to December 31, 2019. Main Outcomes and Measures The primary outcome was the proportion of patients who did not experience an EM flare within 6 months of initiating thalidomide treatment for recurrent EM or with complete clearance at 6 months for persistent EM (complete remission). Results Overall, 35 patients with chronic EM (median [range] age, 33 [15-65] years; 20 [57%] female) experienced failure of at least 1 previous treatment prior to initiating treatment with thalidomide. After 6 months of continuous thalidomide treatment, 23 (66%) were in complete remission, 5 (14%) had stopped the treatment, and 7 (20%) experienced at least 1 flare. The median (IQR) initial dose followed by remission was 50 (50-100) mg/d. Main adverse effects were asthenia (16 [46%]) and neuropathy (14 [40%]). Twenty-five (71%) of patients stopped thalidomide treatment after a median (IQR) of 12 (8-20) months owing to lack of effect (7/25 [28%]), neuropathy or another adverse effect (14/25 [56%]), or long-term complete remission (4/25 [16%]). Low-dose thalidomide, less than 50 mg every other day was sufficient in 9 of 23 (39%) of responders and was associated with less neuropathy and longer treatment duration. Conclusions and Relevance In this cohort study, second-line therapy with thalidomide was associated with complete remission in two-thirds of the 35 patients with chronic EM. However, adverse events were a common cause of thalidomide withdrawal. In the long term, dose reduction when possible may allow for continuation by improving tolerance.
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Affiliation(s)
- Camille Roux
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Emilie Sbidian
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France.,Université Paris Est Créteil EpiDermE, Créteil, France
| | - Jean-David Bouaziz
- Department of Dermatology, Saint-Louis Hospital, AP-HP, Université de Paris, Paris, France
| | - Diane Kottler
- Department of Dermatology, Bichat Hospital, AP-HP, Université de Paris, Paris, France.,Department of Dermatology, Caen University Hospital, Caen, France
| | - Pascal Joly
- Department of Dermatology, Rouen University Hospital and INSERM 1234, Normandie University, Rouen, France
| | - Vincent Descamps
- Department of Dermatology, Bichat Hospital, AP-HP, Université de Paris, Paris, France.,Department of Dermatology, Caen University Hospital, Caen, France
| | - Catherine Prost
- Department of Dermatology, Avicenne Hospital, AP-HP, Bobigny, France
| | - Mahtab Samimi
- Department of Dermatology, University Hospital of Tours, Tours, France
| | - Julien Seneschal
- Department of Dermatology, National Reference Center for Rare Skin Diseases, Université Bordeaux, Bordeaux, France
| | - Nicolas Dupin
- Department of Dermatology, Cochin Hospital, AP-HP, Paris, France
| | - Céline Girard
- Department of Dermatology, Montpellier University Hospital, Montpellier, France
| | - Muriel Paul
- Université Paris Est Créteil EpiDermE, Créteil, France.,Department of Hospital Pharmacy, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Laurence Le Cleach
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France.,Université Paris Est Créteil EpiDermE, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Henri Mondor Hospital, AP-HP, Créteil, France.,Université Paris Est Créteil EpiDermE, Créteil, France.,Reference Center for toxic bullous dermatoses and severe drug reactions TOXIBUL, Créteil, France
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25
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Reis VP, Bezerra AR, Maia ABP, Marques LC, Conde DC. An integrative review of oral manifestations in patients with COVID-19: signs directly related to SARS-CoV-2 infection or secondary findings? Int J Dermatol 2021; 61:278-290. [PMID: 34541674 PMCID: PMC8653326 DOI: 10.1111/ijd.15881] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/01/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
We conducted an integrative review on oral manifestations in patients with COVID‐19 based on the current available literature evidence. A bibliographic search was carried out on March 11, 2021, among published studies in the years 2019–2021 in the PubMed database and based on the search strategy (“COVID‐19” AND “oral lesions” OR “oral mucositis” OR “oral manifestation”). After applying the inclusion and exclusion criteria, 29 articles were considered suitable for this review. A total of 110 cases of patients with COVID‐19 who had oral manifestations were reported. The presence of ulcerated lesions was the most common finding, having a herpetiform and aphthous clinical pattern observed in most cases. Macules, petechiae, hemorrhagic blisters, pustular enanthem, mucositis, and halitosis were also among the most frequently described oral manifestations. The tongue was the most commonly affected site, followed by the palate and lip. Most of the reported cases were diagnosed only by the clinical aspect of the lesion associated with a positive SARS‐CoV‐2 test or the presence of other COVID‐19 symptoms. Current scientific evidence still could not affirm that most of the oral lesions observed in patients with COVID‐19 are related to the virus's direct or indirect action on the oral mucosa. To confirm this association, prospective and longitudinal studies are further needed, together with a larger number of patients, complemented by histopathological examination of these lesions. Additionally, molecular techniques, such as immunohistochemistry and in situ hybridization, may be necessary to perform the differential diagnosis with other oral lesions.
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Affiliation(s)
- Vanessa Paiva Reis
- Oral Maxillofacial Surgery and Traumatology Service, Military Police Polyclinic of Cascadura (Policlínica da Polícia Militar de Cascadura), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
| | - Adriana Raymundo Bezerra
- Oral Maxillofacial Surgery and Traumatology Service, Military Police Central Dental Clinic (Odontoclínica Central da Polícia Militar), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
| | - Adriane Batista Pires Maia
- Oral Maxillofacial Surgery and Traumatology Service, Military Police Central Hospital (Hospital Central da Polícia Militar), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
| | - Letícia Côgo Marques
- Dentistry Sector, Healthcare and Social Assistance Section of The Universidade Federal do Espírito Santo (UFES), Vitória, Brazil.,Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, Brazil
| | - Danielle Castex Conde
- Postgraduate Program in Pathology, School of Medicine, Universidade Federal Fluminense (UFF), Niterói, Brazil.,Oral Maxillofacial Surgery and Traumatology Service and Anatomical Pathology Service, Military Police Central Hospital (Hospital Central da Polícia Militar), Rio de Janeiro State Military Police, Rio de Janeiro, Brazil
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26
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Dalipi ZS, Dragidella F, Dragidella DK. Oral Manifestations of Exudative Erythema Multiforme in a Patient with COVID-19. Case Rep Dent 2021; 2021:1148945. [PMID: 34476106 PMCID: PMC8408009 DOI: 10.1155/2021/1148945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/17/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a viral infection with multiorgan manifestations that may affect the oral mucosa. The full range of oral manifestations of COVID-19 are unknown, and there are limited reports describing the features of oral manifestations of COVID-19, including taste loss, oral lesions, and xerostomia. The aim of this study is to report a case of oral erythema multiforme (EM) manifesting as oral, lip, and skin lesions in a COVID-19 patient. The presence of oral lesions in the late stage of COVID-19 could be related to weak patient immunity or related therapies.
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Affiliation(s)
- Zana Sllamniku Dalipi
- Department of Periodontology and Oral Medicine, University Dentistry Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Street Lagjja e Spitalit p.n., 10000 Prishtina, Kosovo
| | - Fatmir Dragidella
- Department of Periodontology and Oral Medicine, University Dentistry Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Street Lagjja e Spitalit p.n., 10000 Prishtina, Kosovo
| | - Donika Kastrati Dragidella
- Department of Periodontology and Oral Medicine, University Dentistry Clinical Center of Kosovo, Medical Faculty, University of Prishtina, Street Lagjja e Spitalit p.n., 10000 Prishtina, Kosovo
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27
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Zhang M, Zhang M, Ju M, Xu H. A woman with recurrent erythema and vesicles on her legs. BMJ 2021; 374:n1494. [PMID: 34289972 DOI: 10.1136/bmj.n1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Min Zhang
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Mengli Zhang
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Mei Ju
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, Jiangsu, China
| | - Haoxiang Xu
- Institute of Dermatology, Chinese Academy of Medical Science and Peking Union Medical College, Nanjing, Jiangsu, China
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28
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Chiang ML, Jin YT, Chang JYF, Chiang CP. Bee propolis-induced erythema multiforme. J Formos Med Assoc 2021; 120:1652-1654. [PMID: 33757675 DOI: 10.1016/j.jfma.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 08/12/2020] [Accepted: 03/03/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Meng-Ling Chiang
- Department of Pediatric Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan; Department of Oral Pathology and Oral Diagnosis, Chang Gung Memorial Hospital, Taipei, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Tai Jin
- Department of Pathology, Taiwan Adventist Hospital, Taipei, Taiwan; Department of Pathology, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - Julia Yu-Fong Chang
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Chun-Pin Chiang
- Graduate Institute of Oral Biology, School of Dentistry, National Taiwan University, Taipei, Taiwan; Department of Dentistry, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Dentistry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
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29
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Decroos F, Grote C, Broyer J, Steinkraus V. [Generalized rash with osimertinib therapy for non-small cell bronchial carcinoma]. Hautarzt 2021; 72:178-180. [PMID: 32852597 DOI: 10.1007/s00105-020-04671-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Florence Decroos
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland.
| | - Carolin Grote
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland.
| | - Jasmin Broyer
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
| | - Volker Steinkraus
- Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland
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30
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Cattelan L, Zargham H, Sasseville D, Maedler Kron C, Jafarian F. Erythema multiforme-like eruption associated with plant-induced allergic contact dermatitis in a pediatric patient: A case report. Pediatr Dermatol 2021; 38:246-248. [PMID: 33247467 DOI: 10.1111/pde.14450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/17/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
An 11-year-old boy presented to the emergency department 5 days after playing in the forest. His initial eruption, consistent with allergic contact dermatitis to poison ivy, progressed into target lesions involving his extremities, palms, upper trunk, and face, consistent with an erythema multiforme-like eruption. This report details the case and reviews the literature concerning this atypical and potentially underreported complication of plant-induced allergic contact dermatitis.
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Affiliation(s)
- Leila Cattelan
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Hanieh Zargham
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | - Denis Sasseville
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
| | | | - Fatemeh Jafarian
- Division of Dermatology, McGill University Health Centre, Montreal, QC, Canada
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Mounica IL, Tejaswi K, Chennaiah T, Thanmai JV. Erythema multiforme: integrating the superfluous diagnosis to a veracious conclusion (case report). Pan Afr Med J 2020; 37:129. [PMID: 33425162 PMCID: PMC7755351 DOI: 10.11604/pamj.2020.37.129.25295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
Erythema multiforme (EM) is an acute, self-limiting hypersensitivity reaction that ranges from a mild cutaneous, exanthematous variant with minimal oral involvement to a progressive fulminating severe variant with extensive mucocutaneous epithelial necrosis (SJS & TEN). Knowing the etiological spectrum is the key for management in EM where sometimes leads to mortality. There are no specific diagnostic tests for EM, diagnosis is mainly clinically supported. Here in we report series of cases of EM with different etiological spectrum.
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Affiliation(s)
- Inukonda Lakshmi Mounica
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
| | - Katne Tejaswi
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
| | - Tirumala Chennaiah
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
| | - Janumpally Varshitha Thanmai
- Department of Oral Medicine and Radiology, SVS Institute of Dental Sciences, Mahabubnagar-509002, Telangana, India
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Al Ismaili A, Al Busaidi K, Nalawade T, Saraf S. Immune-mediated Skin Disorders and their Oral Manifestations in the Omani Population: A Hospital-based Study. Oman Med J 2020; 35:e84. [PMID: 32042465 PMCID: PMC6976739 DOI: 10.5001/omj.2020.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 03/25/2019] [Indexed: 01/01/2023] Open
Abstract
Objectives We sought to determine the prevalence of immune-mediated skin disorders (IMDs), their oral manifestations, and the related comorbidity among Omani patients with IMDs attending the outpatient Department of Dermatology and Dental Clinic at Al Nahdha Hospital, Muscat. Methods We conducted a retrospective study of 236 newly-diagnosed patients with IMDs who attended the outpatient clinic between September 2014 and September 2017. Data, such as age, sex, investigations, diagnosis, comorbidity, and associated oral manifestations of the affected individuals, were collected from the hospital health information system. Results Of the 236 diagnosed cases of IMD, lichen planus substantially comprised over half of the total cases (59.7%). This was followed by relatively fewer cases of discoid lupus erythematosus (11.0%), systemic lupus erythematosus (10.2%), and erythema multiforme (8.1%). Pemphigus vulgaris and bullous pemphigus comprised only 3.0% and 4.2% of the total studied cases, respectively. The other less common disorders found in our study were toxic epidermal necrolysis (1.7%), pemphigus foliaceus (1.3%), and gestational pemphigoid (0.8%). Oral mucosal involvement was seen more commonly with lichen planus (78.7%), pemphigus vulgaris (71.4%), and erythema multiforme (75.0%), while systemic lupus erythematosus and discoid lupus erythematosus were shown to appear with more comorbidities compared to the other skin disorders studied. Conclusions Several IMDs have considerable oral involvement. These oral manifestations of the diseases may be overlooked by other specialists leading to a delay in the diagnosis and its management. In order to circumvent this delay, the analysis and evaluation of a disease need to be done by a team comprising of a dental surgeon, dermatologist, and an oral medicine specialist.
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Affiliation(s)
| | - Khalid Al Busaidi
- Dermatology Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Triveni Nalawade
- Department of Pediatric Dentistry, Oman Dental College, Muscat, Oman
| | - Sanjay Saraf
- Oral Basic Sciences, Oman Dental College, Muscat, Oman
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Chaudhary D, Atal S, Jhaj R, Rupla R. Erythema multiforme induced by tetanus toxoid vaccine. Indian J Public Health 2020; 64:308-310. [DOI: 10.4103/ijph.ijph_335_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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34
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Aktaş H. Bromelain improved long-term erythema multiforme attacks induced by herpes simplex infection : A case report. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.515649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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35
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Abstract
Mucocutaneous diseases affecting the oral cavity are predominantly immune mediated or inflammatory. Three of the most common and clinically significant conditions are reviewed in this article: lichen planus, pemphigus vulgaris, and mucous membrane pemphigoid. Because oral manifestations may be the first or only manifestation of mucocutaneous diseases, oral health professionals play a critical role in the early diagnosis and multidisciplinary management of these conditions.
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36
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Gu Y, Sun J, Zhang J. HSV-associated erythema multiforme in a patient after hematopoietic stem cell transplantation. Dermatol Ther 2019; 32:e13066. [PMID: 31414706 DOI: 10.1111/dth.13066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 11/26/2022]
Abstract
Herpes simplex virus (HSV)-associated erythema multiforme (HAEM) is an acute and self-limiting mucocutaneous hypersensitivity reaction triggered by herpes virus infections. We reported a patient with HAEM after hematopoietic stem cell transplantation (HSCT). A 55-year-old man received HSCT 7 months ago. He suffered from chronic graft versus host disease 4 months after HSCT and was treated with prednisone and tacrolimus. One week ago, he developed generalized macules with leukopenia. Dermatological examination revealed multiple iris-like erythemas on his trunk and extremities. The skin lesions and leukopenia resolved upon anti-HSV treatment.
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Affiliation(s)
- Ying Gu
- Peking University People's Hospital, Beijing, China
| | - Jing Sun
- Peking University People's Hospital, Beijing, China
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37
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Triggers, clinical manifestations, and management of pediatric erythema multiforme: A systematic review. J Am Acad Dermatol 2019; 81:813-822. [PMID: 31331726 DOI: 10.1016/j.jaad.2019.02.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/20/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022]
Abstract
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.
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van den Ende T, Menting SP, Ambarus CA, van Oijen MGH, van Laarhoven HWM. Cutaneous Toxicity After Chemoradiotherapy and PD-L1 Inhibition in Two Patients with Esophageal Adenocarcinoma: More than Meets the Eye. Oncologist 2019; 24:e149-e153. [PMID: 30902915 DOI: 10.1634/theoncologist.2018-0674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/21/2019] [Indexed: 11/17/2022] Open
Abstract
Dermatological adverse events have frequently been reported after immune checkpoint inhibition. When an adverse event occurs during combination of immune checkpoint inhibition with chemotherapy, the question arises which agent is responsible. Unnecessary withdrawal of either chemotherapy or immunotherapy could lead to suboptimal treatment outcomes. Here we report on two patients who developed a cutaneous drug reaction with fever during treatment with paclitaxel, carboplatin, radiotherapy, and PD-L1 inhibition (atezolizumab) for resectable esophageal adenocarcinoma. In the first case atezolizumab was suspected, and in the second paclitaxel. We discuss the clinical manifestation, treatment, and pathophysiology underlying both cases.
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Affiliation(s)
- Tom van den Ende
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Stef P Menting
- Department of Dermatology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Carmen A Ambarus
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn G H van Oijen
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Cancer Center Amsterdam, Amsterdam, The Netherlands
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Cutaneous Adverse Effects of Diabetes Mellitus Medications and Medical Devices: A Review. Am J Clin Dermatol 2019; 20:97-114. [PMID: 30361953 DOI: 10.1007/s40257-018-0400-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Diabetes mellitus is one of the most prevalent chronic diseases in the USA. If uncontrolled, diabetes can lead to devastating complications. Diabetes medications and medical devices largely contribute to the significant financial expense that the disease inflicts on affected individuals and society. Alongside significant economic burden, there are numerous cutaneous adverse effects associated with diabetes medications and medical devices. Despite the large and increasing number of individuals living with diabetes and the wide use of the related medications and medical devices, there is limited literature that comprehensively documents their cutaneous adverse effects. These cutaneous adverse effects are significant as they can worsen glycemic control, increase disease distress, and may increase risk of associated complications. Thus, it is important that providers can recognize these cutaneous adverse effects, identify the culprit agents, and can properly manage them. In this article, we provide a critical review of the cutaneous adverse effects of medications and devices used in the management of diabetes and provide insight into risk factors and prevention and an overview of therapeutic management. An emphasis is placed on clinical recognition and treatment for use of the medical providers who, regardless of practice setting, will treat patients with diabetes.
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40
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Adverse Immunologically Mediated Oral Mucosal Reactions to Systemic Medication: Lichenoid Tissue Reaction/Interface Dermatitis-Stomatitis, Autoimmune Vesiculobullous Disease, and IgE-Dependent and Immune Complex Reactions. J Immunol Res 2018; 2018:7645465. [PMID: 29984259 PMCID: PMC6015680 DOI: 10.1155/2018/7645465] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/29/2018] [Indexed: 11/18/2022] Open
Abstract
Drug-induced hypersensitivity immune reactions are exaggerated immunoinflammatory responses to allergenic components of the medications that occur in genetically susceptible subjects. The type of hypersensitivity immune response generated, whether antibody mediated or T cell mediated, or an immune complex reaction is determined by multiple factors, including the molecular characteristics of the allergen, the route of administration of the medication, the manner of presentation of the allergen by antigen-presenting cells to naïve T cells, the repertoire of the T cell receptors, and the cytokine profile within the microenvironment. This review deals with the clinical and histopathological aspects of adverse immunologically mediated oral mucosal reactions to systemic medication. We elaborate on diseases showing features of lichenoid tissue reaction/interface dermatitis-stomatitis, autoimmune vesiculobullous oral lesions, and immunoglobulin E- (IgE-) and immune complex-mediated oral reactions to drugs.
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41
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From HSV infection to erythema multiforme through autoimmune crossreactivity. Autoimmun Rev 2018; 17:576-581. [PMID: 29635075 DOI: 10.1016/j.autrev.2017.12.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 12/24/2017] [Indexed: 12/26/2022]
Abstract
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.
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42
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Sousa-Pinto B, Araújo L, Freitas A, Correia O, Delgado L. Stevens-Johnson syndrome/toxic epidermal necrolysis and erythema multiforme drug-related hospitalisations in a national administrative database. Clin Transl Allergy 2018; 8:2. [PMID: 29387340 PMCID: PMC5776772 DOI: 10.1186/s13601-017-0188-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/19/2017] [Indexed: 12/17/2022] Open
Abstract
Background Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and erythema multiforme (EM) are immunologically-mediated dermatological disorders commonly triggered by drug exposure and/or other external agents. We aimed to characterise SJS/TEN- and EM-drug-related hospitalisations in a nationwide administrative database, focusing on demographic and clinical characteristics, and in the most frequently implicated drug classes. Methods We analysed all drug-related hospitalisations with associated diagnosis of SJS/TEN or EM in Portuguese hospitals between 2009 and 2014. We compared gender, age, comorbidities, length of stay, and in-hospital mortality and estimated the number of episodes per million packages sold of drug classes. Predictors of in-hospital mortality were investigated in both conditions by logistic regression. Results There were 132 SJS/TEN-related and 122 EM-related hospitalisations. Incidence and in-hospital mortality of SJS/TEN episodes (24.2%) were consistent with previous studies. HIV co-infection was more common among SJS/TEN hospitalisations (9 vs. 2% with EM; P = 0.009). Liver disease, advanced age, and a TEN diagnosis, were significantly associated with higher risk of mortality in patients with SJS/TEN. The highest numbers of SJS/TEN and EM episodes per million drug packages sold were observed for antivirals (8.7 and 1.5, respectively), antineoplastic/immunosuppressive drugs (5.6 and 3.9, respectively) and hypouricaemic drugs (5.0 and 2.4, respectively). Conclusions SJS/TEN in-hospital mortality is high, and its risk factors include advanced age, liver disease, and TEN diagnosis. The drug classes most frequently associated with these conditions include antivirals, hypouricaemic drugs and antineoplastic/immunosuppressive drugs. Administrative databases seem useful in the study of SJS/TEN drug-related hospitalisations, yielding results consistent with previous studies and on a nationwide basis. Electronic supplementary material The online version of this article (10.1186/s13601-017-0188-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bernardo Sousa-Pinto
- 1Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,2MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal
| | - Luís Araújo
- 1Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.,Allergy Unit, CUF Institute, Porto, Portugal
| | - Alberto Freitas
- 2MEDCIDS - Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal
| | - Osvaldo Correia
- 1Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.,Epidermis Dermatology Center, CUF Institute, Porto, Portugal
| | - Luís Delgado
- 1Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.,CINTESIS - Center for Health Technology and Services Research, Rua Dr. Placido da Costa, 4200-450 Porto, Portugal.,Allergy Unit, CUF Institute, Porto, Portugal
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43
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Ranugha PSS, Betkerur J. Antihypertensives in dermatology Part II - Cutaneous adverse reactions to antihypertensives. Indian J Dermatol Venereol Leprol 2018; 84:137-147. [DOI: 10.4103/ijdvl.ijdvl_992_16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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44
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de Arruda JA, Silva P, Amaral MB, Cotta F, Avendanho R, Mesquita R. Erythema multiforme induced by alendronate sodium in a geriatric patient: A case report and review of the literature. J Clin Exp Dent 2017; 9:e929-e933. [PMID: 28828163 PMCID: PMC5549594 DOI: 10.4317/jced.53653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 05/27/2017] [Indexed: 12/04/2022] Open
Abstract
Erythema multiforme is an uncommon acute inflammatory disorder caused by exposure to microbes or drugs. Erythema multiforme minor typically affects only one mucosa and can be associated with symmetrical target skin lesions on the extremities. The disease usually occurs in patients in their 3rd and 4th decade of life, but can also affect children and adolescents. Alendronate sodium has been approved for the prevention and treatment of osteoporosis in postmenopausal women, but is associated with adverse events. This study reports and discusses a case of erythema multiforme minor. In addition, a literature search of articles published in PubMed-Medline was performed. The case was a 96-year-old woman who had taken alendronate. Intraoral clinical examination demonstrated hypersalivation and macrocheilia of the lower lip, associated with an ill-defined ulcer with erythematous borders measuring 20 mm in greatest diameter and covered with serofibrinous exudates. The aging of the population in developed and developing countries has increased the use of alendronate sodium to prevent osteoporosis and clinicians should be aware of possible oral adverse events associated with this drug.
Key words:Adverse events, erythema multiforme, therapeutics, diagnosis, alendronate.
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Affiliation(s)
- José-Alcides de Arruda
- Department of Oral and Maxillofacial Pathology, School of Dentistry, Universidade de Pernambuco, Camaragibe, Brazil
| | - Pedro Silva
- Department of Stomatologic Sciences, School of Dentistry, Universidade Federal de Goiás, Goiânia, Brazil
| | - Márcio-Bruno Amaral
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Fernanda Cotta
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Renata Avendanho
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ricardo Mesquita
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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45
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Zanella LGD, Sampaio ÉF, Lellis RF. Erythema multiforme triggered by Treponema pallidum infection in an HIV-infected patient. Int J STD AIDS 2017; 29:99-102. [PMID: 28820345 DOI: 10.1177/0956462417726203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Érika F Sampaio
- 1 Emilio Ribas Infectious Diseases Institute (IIER), São Paulo, Brazil
| | - Rute F Lellis
- 1 Emilio Ribas Infectious Diseases Institute (IIER), São Paulo, Brazil.,2 Medical School of Santa Casa, São Paulo, Brazil
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46
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Ikeda K. Drug-Induced Oral Complications. Atlas Oral Maxillofac Surg Clin North Am 2017; 25:127-132. [PMID: 28778302 DOI: 10.1016/j.cxom.2017.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kentaro Ikeda
- Department of Diagnostics and Biological Sciences, University of Colorado School of Dental Medicine, 13065 East 17th Avenue, Mail Stop F844, Aurora, CO 80045, USA; Department of Family Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA.
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47
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AAOM Clinical Practice Statement Subject: Medication-induced Oral Reactions. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 124:369-370. [PMID: 28743665 DOI: 10.1016/j.oooo.2017.05.510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
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48
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Cho M, Lee DH, Doh EJ, Kim Y, Chung JH, Kim HC, Kim S. Development and clinical validation of a novel photography-based skin erythema evaluation system: a comparison with the calculated consensus of dermatologists. Int J Cosmet Sci 2017; 39:426-434. [DOI: 10.1111/ics.12393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/04/2017] [Indexed: 12/30/2022]
Affiliation(s)
- M. Cho
- Interdisciplinary Program for Bioengineering; Graduate School; Seoul National University; Seoul 110-744 Korea
| | - D.-H. Lee
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - E. J. Doh
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - Y. Kim
- Department of Biomedical Engineering; Seoul National University Hospital; Seoul 110-744 Korea
| | - J. H. Chung
- Department of Dermatology; Seoul National University Hospital; Seoul 110-744 Korea
| | - H. C. Kim
- Department of Biomedical Engineering; Seoul National University College of Medicine; Seoul 110-799 Korea
- Institute of Medical and Biological Engineering; Seoul National University; Seoul 151-742 Korea
| | - S. Kim
- Department of Biomedical Engineering; Seoul National University College of Medicine; Seoul 110-799 Korea
- Institute of Medical and Biological Engineering; Seoul National University; Seoul 151-742 Korea
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Abstract
The people who are treated in the community setting will often have multiple comorbidities. Systemic medical conditions can have a negative impact on oral health. In addition, the medications used to treat systemic conditions may also themselves cause oral symptoms. As a large proportion of patients treated by the community nursing team will be elderly, this paper will focus on common geriatric conditions that can display oral or dental symptoms. The effects of medications will be discussed and linked to oral complaints patients may express. The primary aims are to give a broad overview of the oral effects of ageing, of illness and of polypharmacy and advise on how these can be best managed by the nursing team.
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Affiliation(s)
- Diana Critchlow
- Senior Dental Officer, Northeast London NHS Foundation Trust, Dental Department, Grays Health Centre
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50
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Thongprasom K. Treatment of a Pregnant Patient with Herpes Associated Erythema Multiforme (HAEM): A case report. Acta Stomatol Croat 2016; 50:265-268. [PMID: 27847401 DOI: 10.15644/asc50/3/10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Erythema Multiforme, (EM) is an uncommon, acute inflammatory disease of the skin and mucous membranes characterized by ulcerations caused by hypersensitivity to drugs, microbial agents or other allergens. An EM outbreak can result in more severe forms of EM involving the skin, and there are several types of EM manifestations. A hemorrhagic crust on the lip is a pathognomonic sign of this disease. Target lesions may or may not be present in EM cases. When target lesions are not present on the skin, it is very difficult to make a differential diagnosis of EM. Herpes associated erythema multiforme (HAEM) is an uncommon lesion caused by herpes simplex virus infection. A case of severe painful lesions in a 28-year-old pregnant patient with HAEM is presented here. HAEM is rarely found in pregnant women, and its clinical findings, diagnosis and treatment have not previously been reported.
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Affiliation(s)
- Kobkan Thongprasom
- Oral Medicine Department, Faculty of Dentistry Chulalongkorn University, Bangkok, Thailand
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