Sriram Shyamkumar, Jayakanth Mambakkam J, Mariam Sarah, Saeed Shazina, Hasan Shamimul
Department of Rehabilitation and Health Services, College of Health and Public Service, University of North Texas, Denton, USA.
Department of Internal Medicine, Patiala Heart Institute, Patiala, IND.
Cureus. 2024 Oct 7;16(10):e70977. doi: 10.7759/cureus.70977. eCollection 2024 Oct.
Erythema multiforme (EM) is an acute-onset, self-limiting inflammatory condition affecting the skin and mucous membranes. It exhibits a range of skin lesions, which is why it is referred to as "multiforme." Oral lesions, usually inflammatory and frequently marked by rapidly rupturing vesicles and bullae, often constitute a significant clinical feature. The exact etiology is obscure; however, it may be caused by multiple triggering factors. The most well-established connection is with a previous herpes simplex virus infection, while a smaller percentage of cases (<10%) are linked to drug use. Based on mucosal involvement, the condition is classified into two types: EM minor and EM major. Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's disease) are now recognized as separate clinical conditions. EM usually exhibits a self-limiting course, with lesions typically improving within a few weeks. Avoiding triggers and using steroid therapy can be effective treatments. This paper documents a rare case of drug-induced oral EM featuring characteristic lip and intraoral lesions. The patient developed painful oral ulcers and difficulty in swallowing after taking azithromycin for a sore throat and fever. Clinical examination revealed multiple, hemorrhagic encrustations on the lips, along with ulcers on the right buccal mucosa and vesicular eruptions on the palate. The acute onset of multiple oral ulcers associated with a recent drug intake led to a diagnosis of drug-induced oral EM. Treatment included systemic prednisolone, topical triamcinolone paste, and supportive oral care. No recurrence was observed during the six-month follow-up.
多形红斑（EM）是一种急性发作、自限性的炎症性疾病，累及皮肤和黏膜。它表现出一系列皮肤损害，这就是它被称为“多形”的原因。口腔损害通常为炎症性，常以迅速破溃的水疱和大疱为特征，往往构成重要的临床特征。确切病因尚不清楚；然而，它可能由多种触发因素引起。最明确的关联是与既往单纯疱疹病毒感染有关，而较小比例的病例（<10%）与药物使用有关。根据黏膜受累情况，该病分为两型：轻型多形红斑和重型多形红斑。史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症（莱尔病）现在被认为是单独的临床病症。多形红斑通常呈自限性病程，损害通常在几周内好转。避免触发因素和使用类固醇疗法可能是有效的治疗方法。本文记录了一例罕见的药物性口腔多形红斑病例，其具有典型的唇部和口腔内损害。患者因咽痛和发热服用阿奇霉素后出现疼痛性口腔溃疡和吞咽困难。临床检查发现唇部有多处出血性结痂，右侧颊黏膜有溃疡，腭部有水疱性皮疹。近期服药后急性出现多个口腔溃疡导致诊断为药物性口腔多形红斑。治疗包括全身应用泼尼松龙、局部应用曲安奈德糊剂以及支持性口腔护理。在六个月的随访期间未观察到复发。
