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Erythema multiforme (EM) is an immune-mediated reaction first described by von Hebra1 in 1860, presenting typically as acrofacial target lesions. The rash may be confined to the skin (EM minor), or it may involve ocular, oral, or genital mucosa with systemic symptoms (EM major). In most cases, only 1 outbreak of EM occurs in a lifetime; however, very rarely, repeated episodes of EM may occur, known as recurrent EM.2 Few cases of pediatric recurrent EM have been reported, with the etiology being identified in less than half of these cases.3 We report a pediatric case of recurrent EM resistant to conventional treatments in which a peculiar human leukocyte antigen (HLA) haplotype has been identified.

Adults and children hospitalized with COVID-19 display a range of mucocutaneous eruptions, the diversity of which is likely due to the varying immune response generated in response to SARS-CoV-2 infection. In the hospitalized patient, livedo racemosa and retiform purpura were associated with more severe disease course, poorer prognosis, prolonged hospitalization, and higher mortality. In contrast, most viral exanthem and inflammatory lesions, such as urticarial and vesicular eruptions, were associated with a less severe COVID-19 disease course, although were nevertheless reported more frequently in the inpatient setting. One exception, however, is the presence of an inflammatory rash associated with MIS-C in the inpatient pediatric population, which has been associated with more severe COVID-19 disease and disease sequelae. Prompt recognition of the mucocutaneous manifestations presented in this article is paramount to facilitate timely diagnosis, proper treatment, and accurate prognostication of clinical course.

Fixed drug eruption (FDE) is a type IV hypersensitivity reaction characterized by recurrence of lesions at identical sites with each exposure to the offending medication. After morbilliform exanthems, FDE is the most common cutaneous drug reaction.1 Generalized bullous fixed drug eruption (GBFDE) is a variant of FDE that can present rarely with significant, life-threatening body surface involvement akin to Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).2 There are few reported cases of GBFDE occurring after the influenza vaccine, and all occurred after decades of receiving the vaccine.3, 4 Here we report a rare case of GBFDE occurring as a result of administration of the influenza vaccine.

Erythema multiforme (EM) is an acute, typically self-limited mucocutaneous eruption characterized by distinctive target lesions. In a subset of patients, EM has a more chronic course, with recurrent episodes or even persistent disease. In some of these patients, EM is related to chronic infections, most commonly herpes simplex virus (HSV), and will respond to antiviral therapy. However, in up to 58% of patients, the etiology is unknown,1 and in these cases treatment is often difficult.

Secukinumab is a new human monoclonal antibody targeting interleukin (IL)-17A, a cytokine involved in the pathogenesis of psoriasis. The US Food and Drug Administration approved secukinumab for psoriasis in 2015. Because the medication has been on the market for a short time, adverse events involving the oral mucosa are rarely reported. We report a case of severe, ulcerative, lichenoid mucositis associated with secukinumab use.