A Rare Case of Oral Erythema Multiforme: A Case Report with a Literature Review

Abstract

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction characterized by skin eruptions with or without oral or other mucous membrane lesions. The main two variants are erythema minor and erythema major. Oral disease with typical EM lesions has been suggested as a third variant of EM. Known as oral EM, it is reported less and has no target lesions unlike the other two types, in its primary presentation. Objective: To report a manifestation of a rare case of oral EM and discuss various forms of EM including its management. Case report: A 22-year-old male patient reported with a complaint of oral and lip ulcers and severe pain for the past 7 days. The patient reported spontaneous onset of the lesions in the form of vesicles after consuming unknown artificially colored food items. The vesicles ruptured within two days leaving ulcers on the lips and the intraoral mucosa, with blood encrustations. The patient was unable to take food, was admitted for hydration, and was kept on corticosteroids. It took around three weeks for the patient to completely recover. Conclusion: The positive history of artificially colored food intake followed by the sudden onset of lesions and eruptions on the lips and oral mucosa led us to the diagnosis of oral EM. Early recognition and timely intervention benefits patients because the lesions associated with EM and related disorders can compromise life.

Evaluation of Oral Health-Related Quality of Life in Patient with Herpes-Associated Erythema Multiforme: A Unique Case Report

“…The causative agent is thought to induce a T-cell-mediated immune reaction, resulting in a cytotoxic immunological attack on non-self-antigen-expressing keratinocytes, causing local inflammation such as vesicles, erosions, blisters, or ulceration of the tissue. 1 , 5 …”

“…Farthing et al stated that EM due to herpes accounts for 20–50% of cases. 1 , 8 Investigations to establish the diagnosis of herpes infection are the Tzanck smear, serology, viral culture, and polymerase chain reaction (PCR). This patient underwent an anti-HSV-1 IgG serological examination using the ELISA technique, and the result was positive with a ratio of: 6.32 (positive: ratio > 1.1).…”

“… 1 , 5 In general, EM is classified as EM minor (involvement of ≤1 mucosal site) and EM major (involvement of ≥2 mucosal sites). 1 , 5 , 6 Oral EM is a third type of EM that solely affects the oral mucosa and has no skin involvement. 1 , 5 This case was reported less frequently and did not have a target lesion like the other two variants.…”

“… 1 , 5 , 6 Oral EM is a third type of EM that solely affects the oral mucosa and has no skin involvement. 1 , 5 This case was reported less frequently and did not have a target lesion like the other two variants. EM rarely affects the oral cavity alone, making it a rare entity.…”

“…Ferdinand von Hebra reported Erythema multiforme (EM) for the first time in 1866. [1][2][3] EM is a self-limited acute mucocutaneous hypersensitivity reaction. The characteristics of EM are skin eruptions, with or without oral or other mucous membrane lesions.…”