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.

BackgroundPneumonia remains the leading killer with an estimated of 922,000 fatalities or 15% of all deaths in <5-year-old children in 2013. Mortality can be reduced by providing appropriate treatment to the pathogens. The objectives of this study were to describe the causes of pneumonia that may change after the introduction of vaccines and to identify biomarkers to differentiate between bacterial and viral infection.MethodsA 2-year multicenter cohort study of children between 2-month–5-year old with pneumonia has been conducted in three hospitals in Indonesia since July 2017. Demographics, clinical, laboratory, radiology, treatment data, have been recorded. Blood, urine, nasopharyngeal swab, sputum/induced sputum, specimens have been collected for biomarkers, culture, molecular and serological tests.ResultsThree-thirty from 99 pneumonia subjects screened were enrolled in this study since July 2017. 20 (60.6%) subjects had bacterial and viral coinfection, 10 (30.3%) subjects with bacterial infection, two (6.0%) subjects with viral infection, and one (3.0%) subject had unknown etiology. Demography, clinical signs and symptoms, disease and vaccination history, laboratory, and radiological evaluation are shown in Table 1. The etiologies of pneumonia are described in Figure 1.ConclusionMixed viral and bacterial infection were predominant. Several atypical pathogens were identified. No significant different in biomarkers between viral, bacterial and mixed infection groups was found. This finding highlights the need to improve diagnostic capacity to aid clinicians in pneumonia management. Disclosures All authors: No reported disclosures.