Suwarsa Oki, Dewi Isabella Puspa, Sutedja Endang, Dharmadji Hartati Purbo, Gunawan Hendra, Pangastuti Miranti
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, Indonesia.
Int Med Case Rep J. 2022 Jul 6;15:355-359. doi: 10.2147/IMCRJ.S364608. eCollection 2022.
Recurrent erythema multiforme (REM) may have frequent episodes over a period of several years and is considered to be a hypersensitivity reaction associated with infection or medication. REM is a mucocutaneous disorder which is characterized by targetoid lesions. Most of the cases are caused by herpes simplex virus infection. Systemic corticosteroid is frequently used to treat REM due to its effects in suppressing the disease. When REM is unresponsive to systemic corticosteroid, steroid-sparing treatment needs to be instituted. We reported a case of REM in a 49-year-old male. There were complaints of burning sensations on the skin lesions, along with swelling on both hands. On physical examination, erythematous macules and targetoid lesions were found on both palms, arms, and legs. During hospitalization, dexamethasone 20 mg was administered in a tapering dose but new skin lesions still appeared. Two days after azathioprine 50 mg twice daily was added to the treatment, skin lesions and swelling on the patient's hands were diminished and the burning sensation disappeared. No side effects of azathioprine were found in this patient and no recurrence until two weeks after hospitalization. This case report demonstrated the efficacy of combined treatment of dexamethasone and azathioprine for REM cases unresponsive to systemic corticosteroid.
复发性多形红斑（REM）可能在数年时间内频繁发作，被认为是一种与感染或药物相关的超敏反应。REM是一种以靶形损害为特征的皮肤黏膜疾病。大多数病例由单纯疱疹病毒感染引起。由于全身用皮质类固醇具有抑制该病的作用，故常被用于治疗REM。当REM对全身用皮质类固醇无反应时，需要采用激素替代治疗。我们报告了一例49岁男性的REM病例。患者主诉皮肤损害处有烧灼感，双手肿胀。体格检查发现双手掌、双臂和双腿有红斑性斑疹和靶形损害。住院期间，以递减剂量给予地塞米松20mg，但仍有新的皮肤损害出现。在治疗中加用硫唑嘌呤每日两次、每次50mg两天后，患者手部的皮肤损害和肿胀减轻，烧灼感消失。该患者未发现硫唑嘌呤的副作用，住院两周后无复发。本病例报告证明了地塞米松和硫唑嘌呤联合治疗对全身用皮质类固醇无反应的REM病例的疗效。
