Erythema multiforme

Deba P Sarma, MD Omaha

M, 9 yrs, high fever, acute onset blistering lesions of skin and oral mucosa. Biopsy, right flank.

Diagnosis: Skin, right flank, biopsy: - Erythema multiforme

Comment: Full thickness epidermal necrosis overlying subepidermal vesicle with upper dermal lymphohistiocytic perivascular dermatitis, suggestive of erythema multiforme. There is no acute vasculitis or eosinophilia. A similar histologic appearance may be seen in toxic epidermal necrolysis (Stevens -Johnson syndrome) and staphyloccocal scalded skin syndrome (SSSS). Stevens-Johnson Syndrome is a very rare condition in adult, mostly due to drug hypersentitivity reaction. SSSS is a pediatric disease due to staphylococcal infection with toxin production. Clinical history in this case of a 9-yr-old boy with a possible viral infection and blistering cutaneous and mucosal lesions along with the biopsy finding is suggestive of erythema multiforme. The majority of such cases may be related to types I and II HSV, but many other viral, mycoplasmal and bacterial infections have also been implicated.