Search

Erythema multiforme (EM) is an acute mucocutaneous syndrome mediated by hypersensitivity reactions. Symptoms are often mild and self-limiting but have a high recurrency rate. The disease is more prevalent in adolescents and adults, with incidence in childhood often precipitated by infection of herpes simplex virus type 1. However, EM induced by infection of Mycoplasma pneumonia is a rare occurrence. This paper reports a case of pneumonia induced EM in a 5-year-old child with a typical clinical feature supported by laboratory and chest X-ray features that were confirmed with histopathology. The patient showed significant clinical improvements after antibiotic therapy.

Raloxifene is a drug used in postmenopausal women with osteoporosis. Although hot flashes are known side effects of raloxifene, to the best of our knowledge, erythema multiforme (EM) minor has not been previously reported. Herein, we report about a 74-year-old woman who developed EM minor after the drug alfacalcidol was changed to raloxifene to treat osteoporosis. Skin biopsy revealed a suspicious eczematous drug reaction. The drug-induced lymphocyte stimulation test showed a positive result. The stimulation index was 2.2, and there were no other suspected drugs. Based on these results, we diagnosed the condition as EM minor caused by raloxifene. The patient’s symptoms disappeared after the use of antihistamine drugs and topical steroids. In conclusion, raloxifene can cause EM minor in rare cases.

Erythema multiforme is an uncommon, immune-mediated, acute mucocutaneous condition affecting the skin and mucous membranes. It has various etiological factors, including Herpes Simplex virus, medications, auto-immune diseases and malignancies, but the most common cause is infection by Herpes Simplex virus. The characteristic feature is the presence of “target lesions”. Diagnosis is made by clinical signs and symptoms, along with laboratory tests and histopathological examination when required. It should be differentiated from Urticaria, Stevens-Johnson syndrome, toxic epidermal necrolysis, fixed drug eruptions and other vesiculobullous diseases like Pemphigus. Treatment includes symptomatic or supportive care along with corticosteroids, antivirals if needed and hospitalization in extreme cases. In the present case of drug induced Erythema multiforme, the offending drug was immediately stopped and patient was treated with topical and systemic corticosteroids along with symptomatic treatment, leading to immediate and complete resolution of the symptoms. Keywords: Erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, Erythema multiforme major, Erythema multiforme minor, Vesiculobullous diseases, Herpes Simplex virus.

Erythema Multiforme is an acute, self- limiting inflammatory mucocutaneous condition caused by a hypersensitivity reaction with distinctive clinical eruption manifested as iris or target lesions. It is a life-threatening mucocutaneous disorder where early diagnosis and management are of utmost importance. Erythema Multiforme results from a cell-mediated immune reaction against a precipitating factor. It is clinically characterized by a ‘‘minor'' form and a ‘‘major'' form. In the Erythema Multiforme minor, only one mucous membrane is affected and usually is the oral mucosa. Erythema Multiforme is diagnosed based on stringent clinical findings which are pathognomic as microscopic evaluation carries the least significance. The range of possible etiologies for the oral disease is immense including infectious agents, drugs, food additives, etc. We report a case of a 68-year-old female who presented with a complaint of painful ulcers and burning sensation in her mouth making her difficult to eat & drink. History revealed the usage of clove to get rid of tooth pain following which she developed ulcers in the mouth. In the present case, based on patient history, the clove was found to be a probable etiological agent. The patient was successfully treated with corticosteroids adhering to systemic corticosteroid administrative protocols and no remissions and exacerbations were noticed in 6 months follow up. Early diagnosis of the disease remains essential to promptly initiate appropriate management and proper follow up. Recognition and withdrawal or prevention of contact with the etiological agent is an important step in the management of EM. In the present case, the clove was found to be a probable etiological agent.

Erythema Multiforme (EM) is a hypersensitivity reaction that can be triggered by an infection or particular medications. Erythema multiforme minor (EM minor) represents localized skin lesions with minimal or no mucosal involvement. Only a few case of EM associated with risperidone are found in the scientific literature. In this case report, the administration of the risperidone resulted in the rapid appearance of skin lesions. Erythematous lesions were recovered upon discontinuation of the drug and no new skin lesion was observed. A 52-year-old male patient was admitted to the psychiatry hospital because of developing schizophrenic symptoms. At the time of admission, risperidone was added to her previous drug regimen. Two weeks later, the patient returned with a complaint of progressively increasing rashes over his body. The patient was diagnosed with EM minor. The prescribed risperidone was discontinued due to its side-effect profile and the patient’s drug regimen was changed entirely to the olanzapine, haloperidol, and topical clobetasol. At one month follow up visit, his skin lesions were satisfactorily controlled.

Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and mucous membranes. While minor presentations may occur, significant involvement of oral, nasal, eye, vaginal, urethral, gastrointestinal, and lower respiratory mucous membranes may develop in the course of the illness. GI and respiratory involvement may progress to necrosis. Stevens-Johnson syndrome is a serious systemic disorder with the potential for severe morbidity and even death. The syndrome was first described in 1922, when the American pediatricians Albert Mason Stevens and Frank Chambliss Johnson reported the cases of 2 boys aged 7 and 8 years with "an extraordinary, generalized eruption with continued fever, inflamed buccal mucosa, and severe purulent conjunctivitis". Both cases had been misdiagnosed by primary care physicians as hemorrhagic measles. Erythema multiforme (EM), originally described by Von Hebra in 1866, was part of the differential diagnosis in both cases but was excluded because of the 'character of skin lesions, the lack of subjective symptoms, the prolonged high fever, and the terminal heavy crusting". Despite the presence of leucopenia in both cases, Stevens and Johnson in their initial report suspected an infectious disease of unknown etiology as the cause. In 1950, Thomas divided EM into 2 catagories: erythema multiforme minor (Von Hebra) and Erythema multiforme major (EMM). Since 1983, erythema multiforme major and Stevens-Johnson syndrome had been considered synonymous. In the 1990s, however, Bastuji and Roujeau each proposed that Erythema multiforme major and Stevens-Johnson syndrome are 2 distinct disorders. Several investigators propose that Stevens-Johnson syndrome and Toxic epidermal necrolysis (TEN) represent the same disease at different levels of severity. Although several classification schemes have been reported, the simplest breaks the disease down as follows: * Stevens-Johnson syndrome-A "minor form of TEN", with less than 10% body surface area (BSA) detachment. * Overlapping Stevens-Johnson syndrome/Toxic epidermal necrolysis (SJS/TEN)-Detachment of 10-30% BSA. * Toxic epidermal necrolysis-Detachment of more than 30%BSA.KYAMC Journal Vol. 8, No.-2, Jan 2018, Page 31-35

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.

Antipsychotic agents are known to cause adverse cutaneous reactions. These are supposedly rare with atypical antipsychotic agents. Adverse dermatologic reactions due to antipsychotic agent risperidone are rarely reported. Here, we present a case of risperidone-induced erythema multiforme minor.

An 8 year-old girl presented to the basic health unit for evaluation of ulcers and bubbles on dorsum of tongue with a 3-day evolution. Her mother reported that the patient already had lesions similar when she was 3 years old, without diagnosis. The child had no history of recent herpes virus infection or medication use. On general physical examination there were no alterations. Bleeding ulcers, irregular ulcerations with yellow base, and erythematous were present on dorsum of tongue. Incisional biopsy was performed, and with basis on clinical and histopathologic aspects the diagnosis of erythema multiforme minor was established. The patient was treated with oral corticosteroids presenting total remission of the lesion in 5 days.

Erythema multiforme is an acute skin condition characterized by targetoid lesions and occurs most frequently in young adults, particularly males. There are two variants of this condition, one with mucosal involvement, termed erythema multiforme major, and one without mucosal involvement, known as erythema multiforme minor. Due to the similarities in clinical and histological findings, it was previously believed that erythema multiforme major was indistinguishable from Steven-Johnson syndrome (SJS). However, evidence suggests these are two distinct diseases with a different etiology. It is important for clinicians to readily identify the difference between erythema multiforme from SJS, as the prognosis and mortality rate vary significantly between the two disorders.

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

Erythema multiforme minor is also termed as Fuchs Syndrome.We report a case of Fuchs syndrome due to co-infection with Mycoplasma Pneumoniae and Herpes simplex virus which has rarely been reported in literature.

Erythema multiforme (EM) is an acute, self-limited, and sometimes recurring skin condition that is considered to be a type IV hypersensitivity reaction associated with certain infections, medications, and other various triggers like flavorings and preservatives, such as benzoic acid and cinnamon, immunologic disorders, such as transient selective C4 deficiency of infancy, collagen diseases, vasculitides, sarcoidosis, non-Hodgkin lymphoma, leukemia, multiple myeloma, myeloid metaplasia, and polycythemia, physical or mechanical factors, such as tattooing, radiotherapy, cold, and sunlight, foods, including salmon berries and margarine, malignancy, and hormonal. EM may be present within a wide spectrum of severity. EM minor represents a localized eruption of the skin with minimal or no mucosal involvement. According to a consensus definition, Stevens-Johnson syndrome (SJS) was separated from the EM spectrum and added to toxic epidermal necrolysis (TEN). The two spectra are now divided into the following: (1) EM consisting of erythema minor and major and (2) SJS/TEN. Ciprofloxacin is a second generation fluoroquinolone. Fluoroquinolones are rapidly bactericidal in vitro and are considerably potent against Escherichia coli and various species of Salmonella , Shigella , Enterobacter , Campylobacter, and Neisseria . Mainly used in urinary tract infections, prostatitis, sexually transmitted diseases, gastrointestinal and abdominal infections, respiratory tract infections, bone-joint and soft tissue infections. Metronidazole is a nitroimidazole antimicrobial medication used particularly for anaerobic bacteria and protozoa. It is on the World Health Organizations list of essential medicines, a list of the most important medications needed in a basic health system. Here we report the case of a 39-year-old male patient who presented with EM to the dermatology outpatient department, Adichunchanagiri Hospital and Research Centre. The patient gave a history of taking antimicrobials ciprofloxacin and metronidazole for the treatment of a non-healing wound on the right leg which he sustained in a road traffic accident. The review of the literature has revealed very rare associations of metronidazole and pantoprazole with EM, but cases of ciprofloxacin-induced EM have been reported. Hence, the reported adverse drug reaction has been attributed to ciprofloxacin. In this event, casualty assessment using Naranjo’s scale revealed that ciprofloxacin was a probable cause for the adverse drug reaction.

A one-year-old, intact female, Yorkshire terrier dog was presented with a six-month history of multi - focal, polycyclic erythematous lesions with epidermal collarette formation at the axillae, the trunk and ventral abdomen. The dog had a history of an inappropriate vaccine administration one day prior to the onset of clinical signs. The histopathology of the lesions revealed apoptosis of keratinocytes in the overlying epidermis, hydropic degeneration and lymphocytic exocytosis. The clinical signs and histopathology of the lesions were compatible with erythema multiforme. The skin lesions resolved after treatment with prednisolone combined with azathio - prine for one month. No recurrence of clinical signs occurred during the follow-up period (four months). This is the first case report of erythema multiforme associated with an accidental subcutaneous injection of a Bordetella

Erythema multiforme (EM) is an acute self limiting, blistering and ulcerative allergic response of the skin and mucous membranes. This condition is usually associated with certain infections mainly herpes, medications and other triggers. It may be present within a wide spectrum of severity. The hallmark of erythema multiforme is target lesion with variable mucous membrane involvement. In erythema multiforme minor, only one mucous membrane is affected and it usually is the oral mucosa. Although many suspected etiologic factors have been reported to cause EM, EM minor is regarded as being commonly triggered by HSV. EM typically affects young individuals mainly 2nd to 4th decades. We report a case of EM in a 10 year old boy which is presented in association with HSV infection.

The term Erythema Multiforme (EM) includes a wide and controversial variety of clinical expressions at the present time. This study revises the EM minor characteristics according to the most important publications found in literature. Erythema Multiforme is a distinct dermatologic hypersensitivity pathology characterized by cutaneous or mucous lesions and eventually it can also involve both. In their more severe forms, they appear with occasional visceral involvements. In the EM minor only one mucous membrane is affected and usually is the oral mucosa. When occur in the skin, the lesions usually appear symmetrically in the extremities, in a target form, could be continuous or recurrent and none additional systemic involvement is present for both cases. Nowadays, many authors separate etiologically the several manifestations of the EM spectrum. However, no clinical definition is still accepted thoroughly, making more difficult the comparisons of etiological and clinical aspects, histopathological studies and therapeutic protocols. For the present work, we tried to elucidate through an extensive literature revision some historical and current aspects of EM, focusing mainly the EM minor and its frequent association to HSV (Herpes Simplex Virus), with their diagnostic characteristics and current therapeutics, to facilitate the physician understanding and to favor future researches about this disease.

A 20-year-old college student developed an immunologic hypersensitivity reaction, erythema multiforme minor, 1-2 weeks after receiving a meningococcal conjugate vaccine. He had no history of erythema multiforme, nor had he received any other vaccine or drug therapy. The temporal relationship between the development of erythema multiforme and the vaccination suggests that the meningitis vaccine probably was the causal agent. The occurrence of this distinct cutaneous reaction, with the potential for a serious complication such as erythema multiforme major or Stevens-Johnson syndrome on rechallenge, should serve as a warning against repeated booster vaccinations in patients who develop reactions such as this one.

A 20-year-old healthy white female presents to the emergency department for 2day history of rash that started on the vermilion border of the lips and arms (Fig. 1) which eventually spread to her chest, abdomen, back, and legs. She also has lesions on her palms and soles. The cutaneous lesions are symmetrically distributed and consist of 3 zones: a central erythematous papule, an intermediate edematous ring, and a violaceous periphery. The oral mucosal lesions consist of a fewminor areas of hemorrhagic crusting. She takes ibuprofen as needed for menstrual cramps. Patient recalls taking ibuprofen for 3 consecutive days for menstrual complaints prior to the onset of the oral and skin lesions. The oral lesions are painful and the skin lesions are occasionally itchy. She otherwise feels well and denies fever/chills, shortness of breath, or cough. She denies history of herpes simplex virus or other past medical history. An urgent dermatology consultation is ordered and the patient is diagnosed with erythema multiforme.

We report an interesting ocular finding of bilateral multiple coin-shaped epithelial lesions along with the confocal microscopy findings in a patient following an acute attack of erythema multiforme (EM) minor. A 30-year-old male presented with a history of watering and irritation in both eyes of three days duration. He was diagnosed to have EM minor and was on oral acyclovir. Slit-lamp examination revealed multiple coin-shaped epithelial lesions. Confocal microscopy showed a corresponding conglomerate of hyper-reflective epithelial lesions. The corneal lesions resolved over six weeks with oral steroids and acyclovir. An immunological mechanism is suspected.

Erythema multiforme is a cutaneous reaction pattern precipitated by varied agents, notably herpes simplex and drugs. It predominantly occurs in adolescents and young adults but may be seen at other ages also. While vaccination is rarely a precipitating factor for erythema multiforme, it may occasionally be seen in infants and children. We report here a case of a two month-old infant with lesions of erythema multiforme minor appearing after two weeks following vaccination for DPT, Hepatitis B and influenza.

Erythema multiforme and related disorders comprise a group of mucocutaneous disorders that often compromise the quality of life. The clinical classification of these disorders is variable, thus making definitive diagnosis difficult. Early recognition and prompt management will benefit the patients. This article highlights two such cases of erythema multiforme with detailed literature review on etiopathogenesis, clinical features, and treatment.

Erythema Multiforme (EM) is an acute, immune–mediated condition characterized by the appearance of distinctive target like lesions on the skin. The lesions are often accompanied by erosions or bullae involving the oral, genital and/or ocular mucosa. We report a case of Erythema Multiforme minor (EMm) who initially presented with a non healing bleeding target like lesions over the upper lip and latter developed target lesions on both hands.

Erythema multiforme is an acute condition which usually goes on its own but may require treatment for its symptoms. The name means a redness (erythema) that is of many (multi-) shapes (−forme). In fact, the rash of erythema multiforme can be recognised by the presence of spots that look like small targets (bull's eye shaped ‘target lesions’). These have a dusky red centre, a paler area around this, and then a dark red ring round the edge. Erythema multiforme is usually mild (erythema multiforme minor)-with only a few spots, causing little troubleand clearing up quickly-but there is also a rare but much more severe type (erythema multiforme major/bullous erythema multiforme) that can be life threatening with involvement of the mucus membranes inside the mouth, in the genital area, and on the conjunctiva of the eyes. The present article discusses the management of ararecasereportof Erythema Multiforme.

A 23-month-old boy presented with a 3-day history of headache, sore throat, and cough. He experienced no fever, vomiting, or diarrhea. On examination, his tonsils were enlarged and red. Most of the child’s fingernails were in the process of sloughing off and being replaced by new growth (Figure). All toenails and fingernails were affected and some of the nails had already dropped off. The nail anomaly was first noticed 2 months before, when oral penicillin V was administered for fever and sore throat. The child developed erythema multiforme minor after the first dose with a generalized erythematous papulovesicular rash, target lesions, and toenail and fingernail changes. Penicillin V was discontinued and he was admitted to the

La incidencia excesivamente elevada de problemas periodontales entre la población, dificulta que un número reducido de especialistas los pueda enfrentar. Se funda como premisa que el cuidado periodontal es, en esencia, labor del odontólogo general y que éste no puede pasar por alto la responsabilidad de proveer atención a todo paciente. Las lesiones vesiculo-ampollares-erosivas a nivel bucal y de piel pueden ser causadas por un amplio grupo de patologías. La etiología de éstas mismas también es muy variable, desde causa traumática-química-por contacto, hasta una causa autoinmune. Ocasionalmente es difícil hacer un diagnóstico diferencial para discernir la etiología de las lesiones, es importante conocer los detalles clínicos y aspectos epidemiológicos e histopatológicos de cada ente. El eritema multiforme es una enfermedad eruptiva inflamatoria mucocutánea, aguda polimorfa y autolimitante, que puede aparecer en: mucosa bucal sólo, varias mucosas, piel sola, o ambas. Puede no ser una entidad etiológica, sino un complejo de síntomas o un patrón de reacción que representa muchos factores posibles, como el estrés, medicamentos o enfermedad sistémica. Representa una urgencia en Odontología. Es importante que el odontólogo, las identifique, así como las consecuencias que ocasiona si no se previenen o tratan a tiempo, así como las complicaciones. El propósito del reporte es describir las diferentes presentaciones clínicas, etiopatogenia, epidemiología, diagnóstico, diferenciales, tratamiento, pronóstico, complicaciones y cuidados postoperatorios. Para ello se realizó basado en los lineamientos de la investigación descriptiva documental, una revisión de la literatura nacional e internacional The excessively high incidence on periodontal problems in the population makes it difficult for a reduced number of specialists deal with them. The principal premise is that periodontal care is in essence, the general dentist work and he can not ignore the responsibility to provide adequate attention to every patient. The vesicular-ampulla-erosive lesions in the mouth and skin may be caused by a wide number of pathologies. The ethiology of theses is very variable too, from trauma-chemical contact to an immune cause. Occasionally, it is difficult to make a differential diagnose to know the origin of the injury, it’s important to know all the clinical, epidemiological and histopathological of each entity. The multiforme erithema is an eruptive inflammatory mucocutaneous disease, acute polimorfe and and self-limited that may appear in the mouth mucose only, various mucoses, skin or both. It may not be an ethiological entity, but a group of symptoms or reaction patternthat represents many possible factors, like stress, medicines or systemic disease. It represents an emergency in dentistry. It is important that the dentist identify them as well as their consequences and complications, if they are not treated in time. The purpose of this report is to describe the different clinic presentation, etiology and pathogenesis, epidemiology diagnose, differentials, treatment, prognosis, complications and post surgery care. That’s why a revision of the national and international literature was made based upon on documentary descriptive research techniques

In order to explore a priori hypotheses about drug-induced Stevens-Johnson Syndrome (SJS), a case-control study was initiated using data from COMPASS, a computerized data base consisting of Medicaid claims data. The records of 3.8 million patients in five U.S. states were searched to identify patients with an inpatient diagnosis of ICD-9-CM code 695.1 (erythema multiforme-EM). Out of the total of 367 cases that were identified, primary medical records for 249 were sought and 128 (51.4 per cent) of these were obtained. The remainder could not be obtained because: in 36 (29.8 per cent) the hospital refused to provide medical records; in 33 (27.3 per cent) there were transcription errors; in 20 (16.5 per cent) the state could not translate the identification number, primarily because the patients lost Medicaid eligibility too long before our request; in 27 (22.3 per cent) the hospital could not locate the patient's record; and in 5 (4.1 per cent) there were other reasons. Of those with a medical record, 121 (94.5 per cent) had a skin diagnosis and 109 (85.2 per cent) had a diagnosis compatible with ICD-9-CM code 695.1 specified on their discharge summary. However, in 35 (27.3 per cent) an expert reviewer felt that the discharge diagnosis was incorrect. In 50 (39 per cent) the computer diagnosis was incorrect. Only 19 (14.8 per cent) were judged by the expert reviewer to truly have Stevens-Johnson Syndrome, and an additional 37 (28.9 per cent) were judged to have erythema multiforme minor. Thus, the computerized diagnosis agreed very well with the diagnoses specified on the discharge summary. However, EM is frequently misdiagnosed, ICD-9-CM code 695.1 contains multiple other diagnoses which are not EM, and much of hospitalized EM is EM minor. Thus, studies of SJS cannot be performed except in patients whose medical records are available.

Erythema multiforme may be a mild condition (erythema multiforme minor), or it may be a severe, possibly life-threatening condition (erythema multiforme major or Stevens-Johnson syndrome). Dorzolamide is a carbonic anhydrase inhibitor, which reduces intraocular pressure by suppressing aqueous production. In this paper we report on a patient who developed erythema multiforme following the use of topical dorzolamide.

Erythema multiforme (EM) is an acute, self-limiting, reactive mucocutaneous disease of the skin and mucous membranes described by Hebra in 1866 [1]. EM, as an adverse effect of antipsychotic medication, has been noted with chlorpromazine and other traditional antipsychotics. There are reports of Stevens–Johnson syndrome (SJS), also known as ‘erythema multiforme major’, with carbamazepine–neuroleptic combination [2]. However, cutaneous adverse drug eruptions are rarely noticed with atypical antipsychotics. Olanzapine has been associated with severe generalized pruritic skin eruptions as part of a hypersensitivity syndrome [3] and is also found to cause leukocytoclastic vasculitis manifesting as erythematous skin eruptions [4]. However, it has not thus far been found to be associated with EM. In fact, among atypical antipsychotics, there is only one case report of erythema multiforme associated with ziprasidone use in a 47-year-old female [5]. A thorough Pubmed search until 23 February 2006, using the names of individual atypical antipsychotics and ‘erythema multiforme’, did not reveal a single case of EM induced by any other atypical antipsychotic. We describe what we consider the first case of EM induced by risperidone. A.S., a 21-year-old male with no contributory past or family history, had had complex partial seizures for the past 6 years. He had been regularly coming for follow-up at the epilepsy clinic of the Central Institute of Psychiatry, Ranchi, and had remained seizure free for the last 3 years with oxcarbazepine 900 mg day−1. A computed tomographic scan of the brain (contrast study) and EEG had been performed twice in the past and shown no abnormality on either occasion. He was brought for psychiatric consultation in November 2005 with a 2-week history suggestive of an ICD-10 acute polymorphic psychotic disorder without symptoms of schizophrenia following failure in a university examination. Treatment was initiated with oral risperidone 2 mg day−1 which was increased to 4 mg day−1. He was brought by his uncle after 2 weeks with progressively increasing multiple rashes all over the body over the previous 9 days. There was no history suggestive of mucosal bleeding, fever, pulmonary symptoms or intake of any other medicine. On examination, there were multiple raised oedematous papules which were symmetric and acrally distributed. There was no involvement of the mucous membranes. We referred the patient to a dermatologist and stopped risperidone. When he came for follow-up after a month, all lesions had disappeared and he became completely asymptomatic. He received a clinical diagnosis of drug-induced EM minor from the dermatologist and was treated with oral prednisolone for 2 weeks, which was started 2 days after his visit to us. He did not discontinue or reduce the dose of oxcarbazepine at any time. According to the criteria given by Roujeau [6], the acrally distributed raised symmetric oedematous papules with sparing of mucosal membranes as seen in our patient are typical of erythema multiforme minor. The rapid onset upon introduction and reversibility of the skin rashes following discontinuation of risperidone suggests a causal link. Oxcarbazepine is unlikely to be the offending agent, as the drug was continued in the same dose as before. Moreover, a negative history of recurrent EM, recurrent herpes or recent clinical herpes (preceding EM within 3 weeks) reduces the likelihood of herpes infection as a possible aetiology. Similarly, the absence of symptoms suggestive of febrile pneumonia makes the possibility of mycoplasma infection being the causative event highly unlikely. The strength of association was examined using the Naranjo Adverse Drug Reaction Probability Scale [7], in which a score of +5 was obtained suggesting a ‘probable’ link. Adverse cutaneous drug eruptions may vary from benign maculopapular rash to Lyell syndrome and depend mainly on the host response to the drug. Although the precise pathogenesis is still unknown, EM is considered to be the consequence of a cytotoxic immunological reaction against the keratinocytes expressing nonself antigens [8]. We propose that this was induced by risperidone alone or perhaps risperidone in combination with oxcarbazepine. The effect of antipsychotic medications on the immune system is currently being explored and preliminary results indicate that both typical and atypical antipsychotics (including risperidone) can alter the cytokine system in the body [9]. This is the first report to link risperidone with an adverse drug-induced skin eruption, i.e. EM. Considering the wide use of risperidone, it is important that clinicians should be aware of the possibility of EM occurring during its use.

A two-year-old, male English springer spaniel developed severe mucocutaneous ulceration following treatment with trimethoprim-potentiated sulphadiazine. The clinical signs were consistent with Stevens-Johnson syndrome (SJS): there were no target or arciform lesions typical of erythema multiforme minor and major; more than one mucosal surface was affected; epidermal detachment affected less than 10 per cent of the body surface area; and there was a clear history of drug exposure. Systemic signs included a severe hepatopathy, dyspnoea, pyrexia and cachexia. Glucocorticoid therapy was associated with secondary infection by Pseudomonas aeruginosa. The clinical signs rapidly resolved following a single intravenous infusion of 0.51 g/kg human immunoglobulin (ivHIG) as a 5 per cent solution. By blocking FAS/FAS ligand (CD95/CD95L) interactions, ivHIG is thought to prevent keratinocyte apoptosis. It also binds to immunoglobulin G Fc receptors, inhibiting cell activation and cytokine synthesis, neutralises autoantibodies and immune complexes, blocks complement activity, is antimicrobial and increases colloid osmotic pressure. To the authors' knowledge, this is the first report of successful treatment of canine SJS using ivHIG, although it has been used to treat erythema multiforme in a cat and toxic epidermal necrolysis in a dog.

We present 2 cases of erythema multiforme following a combined tetanus and diphtheria revaccination and a combined diphtheria, tetanus, acellular pertussis inactivated polio and Haemophillus influenzae type B vaccine respectively, suggesting vaccines containing diphtheria and tetanus toxoids as a potential precipitating factor to erythema multiforme.

Adverse cutaneous reactions are rare side effects of serotonin-selective reuptake inhibitors (SSRIs) (Lamoreux et al. 2006). The dermatological side effects include rashes, erythema multiforme minor, erythema multiforme major or Steven Johnson syndrome, and toxic epidermal necrolysis (Lamoreux et al. 2006; Mockenhaupt et al. 2008; Levi et al. 2009). Erythema multiforme is a dermatological condition that presents with pinkish red blotches prevalent on the extremities. The lesions are symmetrically placed and are mildly itching, though rare instances of severe itching may occur. Generally, erythema multiforme minor resolves within 7–10 days but can develop to erythema multiforme major and lifethreatening Steven Johnson’s syndrome. The classical presentation is the target lesions, which are composed of a round shape and three concentric regions; a central reddish area, an edematous pink area, and an outer lying red ring. The lesions may blister and can have only two regions, with an absent edematous pink area. The lesions may appear with varying clinical morphology, several days after the etiological event, which lends to the nomenclature—(multiforme). The dermatological presentation presents on a spectrum varying from only cutaneous involved erythema minor, to mucosal affected erythema multiforme major (or Steven-Johnson Syndrome), to severe reaction of toxic epidermal necrolysis (Lamoreux et al. 2006; Levi et al. 2009). The proposed etiology is a hypersensitivity reaction, and causative factors include mycoplasma pneumoniae, herpes simplex virus infections, autoimmune diseases, and medications (Lamoreux et al. 2006; Mockenhaupt et al. 2008; Levi et al. 2009). SSRIs have rarely been implicated with sertraline, the only drug cited for Steven Johnson syndrome and toxic epidermal necrolysis (Bodokh et al. 1992; Mockenhaupt et al. 2008; Lange-Asschenfeldt et al. 2009; Levi et al. 2009). Sertraline has been reported in six cases, all of whom were adults (Gales and Gales 1994; Beauquier and Fahs 1998; Jan et al. 1999; Thedenat et al. 2001; Lange-Asschenfeldt et al. 2009). We present sertraline-induced erythema multiforme in a 9-year-old boy, which to our knowledge is the only case described in a child.