Erythema multiforme-like eruption from trinitrotoluene allergy.
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Various types of skin manifestations of human yersiniosis were examined with routine histological and immunohistological methods. The biopsy material consisted of sixteen cases of erythema nodosum, eight cases of erythema multiforme, and one case of erythema figuratum. The principal histopathological changes in erythema nodosum were septal or diffuse, mild panniculitis and in seven cases also necrotizing vasculitis in small, medium-sized or large arteries. Perivascular lymphocytic infiltration without vasculitis was the most prominent feature in erythema figuratum. By using a polyvalent conjugate, immunoglobulins in vessel walls in the dermis were found in two cases of EM. The rapid course of the skin eruptions and the frequency of necrotizing vasculitis in arteries fit the changes seen in an experimental Arthus reaction, in which necrotizing vasculitis is followed by lymphocytic inflammation consistent with a delayed type of reaction.
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A 21-year-old woman who had been taking several kinds of analgesics to treat dysmenorrhea developed episodic attacks of a purpuric macular eruption and a burning sensation on unexposed areas of the upper chest and back where she had sustained severe sunburn eight months earlier. Target-like lesions developed on these areas after intake of Bufferin, a combination of aspirin and dialuminate. After the eruptions had abated following systemic administration of a corticosteroid agent, a challenge test was performed, using a quarter of a tablet of Bufferin. The patient developed a temporary burning sensation and a erythematous color on the previously sunburned skin. We diagnosed this case as a drug eruption due to Bufferin showing erythema exsudativium multiforme with a photo-recall-like phenomenon. In our case, skin tests would be useful to confirm the causal drug.
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The distribution of fibronectin in human oral mucosal vesiculo-bullous diseases was studied by indirect immunofluorescence. Subepithelial (benign mucous membrane pemphigoid and erythema multiforme) as well as intraepithelial (pemphigus vulgaris and dyskeratosis follicularis) lesions were selected. A marked accumulation of fibronectin was generally found in the lamina propria and basement membrane region, except in dyskeratosis follicularis. Intraepithelial staining occurred in erythema multiforme and dyskeratosis follicularis. In pemphigus vulgaris intercellular staining was seen in relation to acantholysis. Both mucous membrane pemphigoid and erythema multiforme showed a linear accumulation corresponding to the intact basement membrane. However, only pemphigoid lesions disclosed fibronectin on the epithelial side of the vesicles.