Condiments Costing High. . . ! A Case Report of Erythema Multiforme

Abstract

A 38-year-old male reported to the Department of Oral Medicine and Radiology, with a complaint of painful mouth due to ulcers since 20 days. Patient was apparently normal 20 days ago following which he developed tooth pain in his upper left back tooth region for which he chewed cloves to overcome pain. After three days he noticed ulcers in his mouth making him difficult in taking solid and liquid foods due to pain which made him to visit a private practitioner where he was administered gentamycin. The oral condition worsened furthermore with the emergence of dermal lesions. General physical examination revealed a history of fever, malaise and headache since two days.Extra oral examination revealed multiple concentric target or iris lesions on upper & lower extremities. Haemorrhagic crustations with clinically evident bleeding were seen on the lower lip with bilateral submandibular lymphadenopathy. Intraorally multiple encrustations were noticed on the upper and lower labial mucosa which were irregular, tender & associated with bleeding. Diffuse erosions and ulcerations with erythematous borders were present on the upper and lower labial mucosa, bilateral buccal mucosa, dorso-ventral surfaces of the tongue and soft palate which were associated with bleeding on palpation and were tender. The dorsum of the tongue is covered with a white patch which is scrappable mimicking coated tongue and is tender [Table/ Fig-1]. Considering the history, Haemorrhagic crustations involving the vermilion border of upper & lower lip along with generalized involvement of oral mucosa and symmetric acral distribution of target/iris/bull eye shaped dermal lesions [Table/ Fig-2] (typical pathognomic feature) in an acute phase a diagnosis of erythema multiforme is made. As mentioned in the review of literature even the histopathological examination remained unremarkable [Table/ Fig-3] The patient was commenced on systemic corticosteroids (Wysolone) 10mg t.i.d. along with benzydamine hydrochloride (tantum) oral rinse for a week. As the lesions were regressing clinically with gradually decreasing discomfort after 15 days [Table /Fig-4,5], systemic steroids were tapered by 10mg for every seven days till a maintenance dose of 5mg. The patient was subjected to quadrant scaling and oral hygiene instructions were given. Total resolution of ABSTRACTAdverse drug associated mucocutaneous reactions having a preponderance to occur above 1% include urticaria, angioedema, photosensitivity, fixed drug eruptions and Erythema Multiforme (EM). EM is an acute inflammatory disease of the skin and mucous membranes that causes a variety of skin lesions-hence named 'multiforme'. The aetiological spectrum of EM is wide and is attributed to infectious agents, drugs and food additives. EM is diagnosed based on stringent clinical findings which are pathognomic as microscopic evaluation carries least significance. We report a case of a 38-year-old male who presented with a complaint of severe oral & cutaneous lesions making him difficult to eat & drink. History rev...

Erythema Multiforme: integrating the superfluous diagnosis to a veracious conclusion

“…Dating back to 1817, EM was first recognized by Bateman and Bulkley. Later, Hebra, in 1866 described the morphologic features of the eruption under the term “erythema exsudativum multiforme” [ 1 ] as an acute mucocutaneous hypersensitivity reaction characterized by skin eruptions that causes a variety of skin lesions-hence named ´multiforme´ with or without mucous membrane lesions [ 2 ]. Etiology spectrum is variable which include drugs (NSAIDs, sulphonamides, phenytoin, and carbamazepine), infectious agents and food additives.…”

“…Diagnosis is purely based on the history and classical presentation itself. Viral research is carried out in viral etiology [ 2 ]. Biopsies are advised only in the early vesicular lesions and not in the ulcerated ones as histopathologic appearances are nonspecific.…”

“…EM has been classified into 2 subgroups, minor and major forms. EM minor (EMm) is mainly a cutaneous disease, mucosal involvement is uncommon and EM major (EMM) typically involves two or more mucous membranes [ 2 ].…”

Erythema Multiforme Minor with Rare Etiology

“…Based on the patient history, clove was found to be a probable etiological agent and the condition was further precipitated owing to the administration of gentamycin. The patient was successfully treated with corticosteroids adhering to systemic corticosteroid administrative protocols and no remissions and exacerbations were noticed in a year follow up [3].…”

“…The exact pathogenesis of EM is still unknown and it has been postulated that EM results from T-cell-mediated immune reaction to the precipitating etiological agent leading to a cytotoxic immunological attack on keratinocytes that express non-self-antigens causing vesicles, blisters and erosions [3]. It is a disease of abrupt onset involving skin and mucous membranes where the lesions appear as red macules, papules, and vesicles.…”