Erythema Multiforme Major

TTILE: Could This Be Multicausal Erythema Multiforme? Case report of Erythema Multiforme Major after recent Antibiotic by an HIV-positive patient who also Tested Positive for HSV and Mycoplasma Pneumonia.

INTRODUCTION
Erythema Multiforme (EM) major is an acute immune reaction (hypersensitivity type 4) which present with skin lesions such as macules, papules, and target-like as well as mucosal involvement. The etiology usually is unclear but it is usually drug-induced or infection. The most common drugs are sulfa and penicillin, Herpes Simplex Virus (HSV)and Mucoplasma pneumonie (M.pneumonie). Most of the cases (50%) occur in the age group 20-40 (50% of cases under 20 and males, or immunocompromised individuals. And 70 % of EM major are …show more content…
After experiencing lower abdominal pain she was diagnosed with diverticulitis and was prescribed Ciprofloxacin 500mg and Flagyl 500mg for 7 days. Two days after starting treatment the abdominal pain improved, however she developed odynophagia, mucosal lesions and rash on her trunk, which eventually spread to her upper extremities and palms. Physical exam revealed crusted papules on trunk and few scattered erythematous papules (including palms). Initially it was thought the rush was due to an drug reaction and she instructed to stop antibiotics and started on oral prednisone 40 mg for 4 days. Patient reported improvement of rash however progression of oral sores, odynophagia and subsequent development of ocular itching, and crusting upon waking, without genital involvement. She endorses chronic cough (smokes 1 pack for 45 years) now with increased production of yellow mucous. Pt gets a rash from bactrim and …show more content…
EM lesions have been associated with orolabial HSV-1 recurrences The cultures help identify HSV only in the samples collected from the eye. The oral samples were negative. This can be explained by the fact that HSV-1 viral shedding usually occurs between 48-60 hours from the onset of herpes labialis symptoms and they are undetectable beyond 96 hours of symptom onset. Our patient was diagnosed with HIV 15 years ago, was on ART suppressive treatment complaint with medication, with a CD4 600(9 months ago) and undetectable viral load (3 months ago). For the patient on a suppressive regimen whose CD4 count has consistently ranged between 300 and 500 cells/mm3 for at least 2 years, the Panel recommends CD4 monitoring on an annual basis. Pt continued to have worsening mucosal involvement despite prednisone therapy. Pt responded to acyclovir therapy which point towards HSEM. Most likely this case report is a case of HSEM aggravated by the use of

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