Drug-mediated rash: erythema multiforme versus Stevens-Johnson syndrome

Abstract

A 92-year-old woman presented with an acute onset generalised maculopapular rash with associated mucosal involvement, on a background of recent start of griseofulvin. The rash progressed rapidly over 2 days to involve most of her body, however, mucosal involvement was limited to her oral mucosa. Characteristic target lesions appeared at 72 h, and a diagnosis of erythema multiforme secondary to griseofulvin was made after further investigation and skin biopsy. The patient was monitored closely for progression of the rash and other indicators of more severe dermatological conditions such as Stevens-Johnson syndrome. She was managed symptomatically, with resolution of the rash in 4 weeks and full recovery to her premorbid level of functioning. This case details the diagnostic and management approach to erythema multiforme, a condition that warrants thorough consideration for the differential of Stevens-Johnson syndrome.

Erythema Multiforme Induced by Tramadol: An Allergy Assessment

“…EM is a well-characterized skin syndrome, it consists of a polymorphous eruption of macules, papules, and characteristic "target" lesions that are symmetrically distributed with a propensity for the distal extremities, with minimal mucosal involvement. EM may have different severity, it has been classified into EM minus (less severe) and EM majus (more severe) [3]. Our case fits in EM minus.…”

Not All Mucosal Rashes After Lamotrigine Are Stevens-Johnson Syndrome

“…It is more prevalent in adolescents and young adults with an average age of 11.9 years, and its prognosis is good with a mortality rate of only 3% 7 . SJS presents with extensive cutaneous involvement on trunk and extremities, and its prognosis is relatively poor with a mortality of 4.8% to 19.4% 8 Erythema multiforme presents with targetoid cutaneous lesions, and its prognosis is fair 9,10 . Key differences in management indicate that early use of high-dose steroids and intravenous immunoglobulin for SJS are critical, while MIRM and erythema multiforme can be generally began with conservative treatment while considering steroids and antibiotics for severe cases 11,12 …”

“…7 There are several case reports already published on trazodone's induced priapism; however, the majority have documented this occurring in patients who are young or middle aged, and whose condition resolved in a matter of days to a week. [8][9][10][11][12] To our knowledge, there has not been any other case report in the literature that describes elderly patients with treatmentresistant priapism, lasting several weeks. Here, we present a case of trazodoneassociated priapism in a 61-year-old male who, despite several pharmacological and surgical interventions, maintained a state of priapism for at least 3 weeks.…”

Suspected case of erythema multiforme major caused by combination therapy of glimepiride, voglibose, and metformin with clomiphene citrate in a polycystic ovary syndrome and type 2 diabetes patient in India

“…Common PCOS symptoms include acne, fertility problems, hair loss, hirsutism, and irregular menstruation or missed periods 6 . Erythema multiforme major (EMM) refers to a severe generalized rash with limited desquamation and mucous membrane involvement with blister formation 7 .…”