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In its most severe form, bullous erythema multiforme is known as the Stevens-Johnson syndrome (SJS). A case of SJS is reported in which ophthalmic complications caused blindness and ultimate enucleation, and in which there occurred permanent loss of nails as well as scarring of the oral mucosa.
Characteristic features of acute annular urticaria in 34 infants and small children were large, erythematous annular and polycyclic lesions with violaceous centers, eyelid, hand, and foot edema, absence of angioedema of the airway, absence of pruritus, spontaneous resolution in 8 to 10 days, and frequent history of furazolidone medication for diarrhea. Nondermatologists often misdiagnose acute annular urticaria as erythema multiforme and unnecessarily overtreat patients. The differential diagnosis with other conditions presenting with annular lesions in children is discussed.
Reports on cases of Stevens-Johnson syndrome (erythema multiforme major) have seldom related it to occupational exposure to chemicals. Serious liver involvement is also uncommon. This report describes 5 cases of the syndrome who had been occupationally exposed to trichloroethylene. The circumstantial evidence suggested that the chemical might have been a causative factor in the disease. The liver was involved in all and in 3 it was serious, with one death. The degree of exposure to trichloroethylene varied. The duration of exposure ranged from 2 to 5 weeks. It seemed likely that there was a hypersensitive reaction to trichloroethylene in these cases.
We have described 100 subjects sensitized to textile dyes. Of these, 16 had clinically been suspected of having a textile dermatitis from among 1145 patients referred for patch testing. 41 patients were identified from among 861 consecutive subjects tested with the GIRDCA (Italian Research Group on Contact and Environmental Dermatitis) standard series supplemented with 4 disperse dyes (Disperse Blue 124, Disperse Red 1, Disperse Yellow 3, Disperse Orange 3). The remaining 43 patients were identified from among 746 subjects tested with the GIRDCA standard series, supplemented with the 4 disperse dyes mentioned above and a further series of 12 other textile dyes. The clinical picture was extremely variable: most patients had a typical eczematous dermatitis, but we also observed persistent erythematous-wheal-type reactions, a transient urticarial dermatitis and an erythema-multiforme-like eruption. Among these textile dyes, Disperse Blue 124 caused most reactions. With the addition of the 4 disperse dyes to the GIRDCA standard series, we identified 4.8% sensitized to textile dyes, a much higher figure than the 1.4% observed among patients being patch tested on the basis of their history and the clinical findings; the addition of a further 12 textile dyes to the series further increased the detection rate to 5.8%. We stress the importance of routinely patch testing with textile dyes, which can help to elucidate the cause of certain kinds of atypical dermatitis.
We have observed 9 male patients with a generalized rash following the topical use of an over-the-counter antiparasitic powder (MOM), containing ammoniated (11.2 g%) and metallic (4.2 g%) mercury, to treat phthiriasis (lice infestation). Primary and intensely erythemato-exudative lesions of the pubic region and genitals were associated with inverted erythema of the upper inner thighs and, in severe cases, involvement of the face, neck, trunk and major flexures. Eruptions included exanthematic, papulo-vesicular, purpuric and erythema-multiforme-like clinical pictures. 7 of the 9 cases presented with general malaise and pyrexia. A positive patch test reaction to ammoniated mercury was observed in all cases. There are probably 3 routes of powder exposure behind this type of rash: (i) direct skin contact; (ii) airborne skin contact; (iii) inhalation.
Human orf is usually considered a rare disease caused by a virus belonging to the paravaccinia subgroup of pox viruses and transmitted to man from sheep and goats. This paper presents 119 new human cases with epidemiological, clinical, histopathological and ultrastructural findings. Erythema multiforme was found to be a common complication of human orf. Other complications tended to be caused by overtreatment. Electron microscopy of negatively stained suspensions from lesions was found to be the best and most rapid diagnostic method available.
Seventy-one biopsy specimens taken at the Mayo Clinic from June 1977 through May 1981 demonstrated lymphocytic vasculitis. All specimens met the criteria for lymphocytic vasculitis, defined as (1) a predominantly lymphocytic infiltrate that involves and surrounds blood vessel walls, (2) fibrinoid necrosis of blood vessel walls, and (3) endothelial cell hyperplasia. Other histologic findings such as thrombosis, extravasation of erythrocytes, ulceration, epidermal infarction, and evidence of nuclear dust were seen only occasionally. Hypocomplementemia and other serologic abnormalities were very rare, even when lymphocytic vasculitis was extensive. The clinical diagnoses varied, with drug reaction (12 patients) and chronic urticaria (10 patients) being most frequent. In 32 cases, no specific diagnosis could be made at the time of dermatologic dismissal. In the remaining 39 cases, the diagnoses were varied and no definite clinical categories can be applied to them. We also observed typical lymphocytic vasculitis in some cases of other clinical entities, such as nodular scabies, erythema multiforme, and urticarial vasculitis, and so forth. We conclude that lymphocytic vasculitis is probably not a specific clinicopathologic entity but is more likely a reactive process, secondary to severe lymphocytic inflammation in the skin.
Carbamazepine is an important drug used in the management of seizures, trigeminal neuralgia, and chronic pain syndromes. It has been associated with a variety of adverse skin reactions including urticaria, lichenoid eruptions, erythroderma, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis. A 39-year-old white male had been started on carbamazepine for intractable pain which resulted from a right foot crush injury. Approximately 3 months after the start of therapy, the patient had developed a generalized skin eruption following an entire day of sun exposure. Skin biopsies revealed an atypical lymphoid infiltrate in the dermis with collections of the atypical lymphocytes within spongiotic vesicles in the epidermis, suggestive of mycosis fungoides. The patient was treated with systemic prednisone. Subsequent biopsies failed to reveal atypical lymphocytes. Previous reports have described spongiotic eruptions with foci of atypical lymphocytes in contact dermatitis and in patients treated with phenytoin. To the best of our knowledge, this is the first reported case of a carbamazepine-induced eruption simulating mycosis fungoides histologically.
Mast cell numbers were quantitated in adult cases of mastocytosis demonstrating non-diffuse perivascular and upper dermal concentrations of mast cells. Using the Leder stain and computerised video image analysis, a mean of 382 (+/- 28 SE) mast cell per mm2 were counted in the superficial dermis in skin biopsies from 30 adult cases of mastocytosis, in contrast to a mean of 43 (+/- 5 SE) mast cells per mm2 in skin biopsies from 50 inflammatory dermatoses represented by subacute dermatitis, pigmented purpuric dermatosis, erythema multiforme, lichen planus and granuloma annulare. Ten skin biopsies showing no significant inflammation had a mean of 54 (+/- 7 SE) mast cells per mm2 in the upper dermis. The mean area of individual mast cells as assessed by image analysis in the mastocytosis group was 47.40 microns 2 (+/- 2.26 microns 2, SE) which was significantly different (P < 0.01) than the mast cell area (32.34 microns 2 +/- 2.22 microns 2, SE) in all other groups combined. Computerised video image analysis represents an alternative technique which is useful in assessing mast cell numbers and particularly mast cell size in adult cases of macular mastocytosis and in other dermatoses.
Toxic epidermal necrolysis (TEN) is a cutaneous, mostly drug-induced reaction pattern characterized by a widespread necrosis and exfoliation of epidermis, involving more than 30% of the body surface area. Photo-induced Stevens-Johnson syndrome and erythema multiforme, which belong to the same spectrum of TEN, have been described before. However, there is only one case of TEN limited to sun-exposed areas, which was caused by clobazam. In this report a second case of TEN because of naproxen, with lesions showing clear-cut borders on sun-exposed body areas resembling a sun-burn reaction, is presented.
OBJECTIVES: To document the incidental oral lesions of human immunodeficiency virus (HIV) infection, the pattern and frequency of the lesions based on clinical presentation and oral manifestations in routine dental patients who tested positive in Nigeria. SUBJECTS AND METHODS: The study was conducted at the Oral Diagnosis/Oral Medicine clinic of the Lagos University Teaching Hospital, Lagos, Nigeria between May 2002 and April 2003. During this period, all patients with oral lesions suggestive of HIV/acquired immunodeficiency syndrome (AIDS) as described in the EEC-WHO Classification and diagnostic criteria of oral lesions of HIV were counseled and offered voluntary HIV testing. All the 35 patients who consented and tested positive were included in this study. RESULTS: Of a total of 700 patients 53 patients with oral lesions suggestive of HIV/AIDS were seen, thirty-eight (72%) consented to HIV screening, 15 patients (28%) refused. Thirty-five patients (92%), mean age 36 +/- 13 years were confirmed positive for HIV. Oral candidiasis was the commonest lesion seen (43%) the second common being Herpes zoster (23%). Other lesions seen included erythema multiforme in two (6%), facial palsy in two (6%) and oral hairy leukoplakia in one (3%). CONCLUSION: An oral mucosal lesion may be the presenting lesion of HIV/AIDS in routine patients attending the dental clinic. Oral health care workers should practice optimal infection control based on the Centers for Disease Control 'Standard Precautions' guidelines on infection control for all patients to minimize occupational transmission of HIV.
A cat was presented with acute-onset exfoliative erythroderma and gross and histopathological lesions of erythema multiforme. Marked cardiovascular abnormalities including heart failure occurred concurrently and a dermatogenic enteropathy was also seen. Medical treatment resolved the dermatopathy and enteropathy but the heart failure progressed. A drug reaction was initially suspected to be the underlying cause with no neoplasia being detected, but repeat radiographs subsequently revealed a thymoma which had not been visible on the initial radiographs. The dermatopathy may have been a paraneoplastic disease associated with thymoma and, possibly, exacerbated by a drug reaction to imidacloprid. The cardiovascular and gastroenterological diseases were thought to be systemic effects associated with the exfoliative erythroderma. The thymoma was surgically removed but the cat subsequently died from heart failure.
Increasingly, patients with complicated medical problems are coming to dental offices for treatment. These patients report using a variety of medications to control one or more chronic conditions. Many of these medications produce changes in the mouth because of toxic overdoses, side effects, allergic reactions, or as a consequence of the primary action of the drug. These effects include: xerostomia, gingival hyperplasia, candidiasis, mucositis, stomatopyrosis, gingival bleeding, petechia, salivary gland problems, intrinsic stain, cheilitis, erythema multiforme, lichen planus, ulcerations, taste changes, tardive dyskinesias, and soft tissue pigmentation. This article discusses presentations and causes of oral changes secondary to systemic drug use.
A case of systemic lupus erythematosus is described in which for 10 years the only significant findings were erythema multiforme and vasculitis. Gross hepatosplenomegaly with persistent pancytopenia developed, and bone marrow examination revealed the presence of sideroblasts. The patient's condition deteriorated, and subsequently she developed a severe bleeding tendency, terminating in erythroleukaemia.
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A 46 year old white woman with active systemic lupus erythematosus developed a skin rash 8 hours after intravenous urography with the non-ionic contrast medium iopamidol. Severe Stevens-Johnson syndrome with erythema multiforme, intrahepatic cholestasis, pulmonary infiltrates and acute renal failure ensued, leading to her death. Although non-ionic contrast media are generally less toxic than traditional ionic agents, their use in patients with immunological disease may be hazardous.
Most cases of drug eruption caused by nonionic contrast media (NICM) reported to date have been of the erythema multiforme type. Herein we report the first case of multiple fixed drug eruption (FDE) caused by iomeprol (Iomeron(R)). A 67-year-old woman developed multiple pea-sized erythematous papules on the trunk and extremities 4 days after receiving 100 ml of iomeprol for a computed tomography examination. Some of the papules coalesced, forming 7 large plaques on the limbs. Six months later, the patient was mistakenly administered iomeprol again. On the following morning, erythematous plaques admixed with vesicles recurred at the same sites as during the previous episode. In both episodes, the lesions cleared leaving pigmentation that faded with 6 weeks. Both patch testing and an intradermal test with iomeprol on lesional pigmented skin were positive. The present case indicates that NICM may cause multiple FDE and that repeated administration of the causative agent may increase the severity of the eruption.