Erythema multiforme

Morning Report
May 24, 2010
Tiffany Milner
 Differential
 Toxic Shock Syndrome
 Erythema multiforme
 SJS/TEN
 DRESS
 Hypersensitivity vasculitis
 Sweet’s syndrome
 Acute lupus
 Acute mycoplasma
 Kawasaki
 Erythema multiforme
 >50% are under 20 years old
 Cutaneous reaction to antigenic stimuli:
- PCN, sulfa, phenytoin, barbituates, allopurinol
- mycoplasma, HSV
- > 50% idiopathic
 Lesions evolve over ~10 days
- macule -> papule -> vesicles/bullae
- target like lesions
 Prefers: hands, feet, face, forearms, elbows, knees, penis, vulva
 Pathology:
- perivascular mononuclear infiltrate, upper dermis edema,
- apoptosis of keratinocytes with focal epidermal necrosis
 Erythema multiforme
 EM minor
- little/no mucus membrane involvement
- vesicles, no bullae
- no systemic symptoms
- usually involves only extremities and face
 EM major
- most often a drug reaction
- mucus membrane involvement
- extensive confluent bullae
- systemic symptoms: fever, prostration, chelitis
 EBV + PCN = rash
 Most patients treated with ampicillin during acute EBV
develop a rash
 The rash is not predictive of future adverse reactions to
penicillin
 Lymphocytosis with > 10% atypical
 Low grade neutropenia and thrombocytopenia, abnormal
LFTs
EM
Atypical lymphocytes
EBV + amoxicillin =
 References
 Fauci et al, Harrisons Principles of Internal Medicine, 17th
edition. 2008
 Wolff, Fitzpatrick’s Color Atlas and Synopsis of Clinical
Dermatology, 5th edition. 2005
 Uptodate, Erythema multiforme. 2010