Persistent erythema multiforme associated with Epstein–Barr virus infection

Erythema multiforme (EM) is a common, self‐limiting condition. Recurrent EM is a well‐recognised variant, often associated with herpes simplex virus infection. It is frequently managed with prophylactic aciclovir. Anecdotal reports suggest that recurrent EM may be associated with the use of corticosteroids. Persistent EM, however, is a rare variant, with few cases reported in the literature. It has a protracted course often with atypical and inflammatory lesions. It has been associated with occult viral infections, particularly Epstein–Barr Virus (EBV), as well as inflammatory bowel disease and malignancy. We report a case of EM associated with EBV infection.     

Two cases of erythema exsudativum multiforme associated with Chlamydia pneumoniae infection

We report two cases of erythema exsudativum multiforme (EEM) that we concluded were caused by infections with Chlamydia pneumoniae. High titers of IgG antibody for Chlamydia pneumoniae were shown in the sera of both cases. One case showed the classical symptoms of pneumonia together with radiological changes in the chest; the other case did not show these symptoms. To the best of our knowledge, only three cases of erythema multiforme associated with Chlamydia pneumoniae infection have been reported.     

Bullous erythema multiforme following herpes zoster and varicella-zoster virus infection

Four cases of herpes zoster-induced bullous erythema multiforme (EM) are reported. Three patients presented with widespread skin lesions 10 to 14 days after an episode of thoracic herpes zoster. In these patients a high increase in varicella-zoster virus (VZV) antibody titer was detected, indicating secondary VZV infection. Histologic examinations of skin biopsy from a patient with widespread lesions (case 4) revealed a mixture of EM, toxic epidermal necrolysis and herpetic virus infection. VZV should be included in the list of infectious agents able to trigger EM and Stevens-Johnson syndrome.     

妊娠期重症多形红斑一例

患者女．27岁，因双眼肿痛4天，双唇红肿水疱3天，躯干红斑2天于2006年4月17日入住我科。入院前4天患者无明显诱因自觉双眼肿痛，无分泌物，无发热，遂到外院就诊，予红霉素眼膏，鱼腥草注射液治疗4天，疗效不佳。3天前出现双眼结膜充血，双唇红肿，唇周出现数个粟粒大小水疱，疱液澄清，易破（图1），口腔黏膜糜烂，表面出现灰白色假膜，疼痛明显，同时外阴也出现糜烂，[第一段]     

Bullous erythema multiforme associated with Hemophilus influenzae pneumonia

A 68-year-old woman with Hemophilus influenzae pneumonia experienced a bullous dermatosis. Further evaluation revealed bullous erythema multiforme of the minor type which resolved concurrently with treatment of the pneumonia. Clinicians should be aware that H. influenzae may be one of the bacterial agents known to cause erythema multiforme.     

以多形红斑为主要表现的梅毒合并HIV感染一例

<正>临床资料患者,男,20岁。1个月前患者无明显诱因躯干及四肢皮肤出现边界清楚的红斑、丘疹,瘙痒明显,伴全身乏力及发热,最高体温达40℃。20天前患者皮疹较前加重,局部糜烂渗出、覆有较厚痂皮。我科曾以"多形红斑、发热待查"予以抗过敏及抗感染治疗,症状未见明显好转。患者既往有男-男性行为史。体格检查:BP 102/50 mmHg,P 120次/分,R 23次/分,T 39℃,食欲差,中等身材,精神差。双侧腋窝可触及多发肿大淋巴结,质硬、     

Drug-induced hypersensitivity syndrome associated with Epstein-Barr virus infection

Association of drug-induced hypersensitivity syndrome with viral infection is debated. Human herpesvirus 6 (HHV-6) reactivation has been the most frequently reported infection associated with this syndrome. However, a case of cytomegalovirus (CMV) infection was recently described associated with anticonvulsant-induced hypersensitivity syndrome. We report a case of severe allopurinol-induced hypersensitivity syndrome with pancreatitis associated with Epstein-Barr virus (EBV) infection. Active EBV infection was demonstrated in two consecutive serum samples by the presence of anti-EBV early antigen (EA) IgM antibodies and an increase in anti-EBV EA IgG antibodies, whereas no anti-EBV nuclear antigen IgG antibodies were detected. EBV DNA was detected by polymerase chain reaction (PCR) in peripheral blood mononuclear cells. Reactivation of HHV-6 was suggested only by the presence of anti-HHV-6 IgM antibodies, but HHV-6 DNA was not detected by PCR in the serum. Other viral investigations showed previous infection (CMV, rubella, measles, parvovirus B19), immunization after vaccination (hepatitis B virus), or absence of previous infection (hepatitis C virus, human immunodeficiency virus). We suggest that EBV infection may participate in some cases, as do the other herpesviruses HHV-6 or CMV, in the development of drug-induced hypersensitivity syndrome.     

Genital ulcers associated with acute Epstein-Barr virus infection

To date there have been only five reported cases of females with genital ulceration associated with primary Epstein-Barr virus infection. We describe two further patients and review the clinical features of all seven cases, noting the typical features, particularly purple ulcer margins and systemic symptoms, which should alert the physician to consider this diagnosis.


     

Herpes associated erythema multiforme annularis concentricum

A young man had large, concentric plaques over the back and extensors of forearms for eight weeks. Past history suggested recurrent herpes labialis. Serum anti HSV-1 IgG titre was raised to 32 micrograms/l and histopathology of an active lesion suggested erythema multiforme. Symptomatic treatment and oral zinc therapy subsided EM lesions but concentric depigmentation developed after healing.