Herpes associated erythema multiforme
Erythema multiforme is an acute and a self-limiting mucocutaneous hypersensitivity reaction triggered by certain infections and medications. One of the most common predisposing factors for erythema multiforme is infection with herpes simplex virus.

Herpes associated erythema multiforme (HAEM) is an acute exudative dermatic and mucosal disease caused by the infecting herpes simplex virus. It has recurrence and idiorestriction, characterized by increasing of CD4+T leukomonocyte. This article reports a case of HAEM in a 9-year-old girl.

A 9-year-old girl presented with history of swelling, pain and ulceration on upper and lower lip since 1 week. Her history of present illness revealed that she had fever and sore throat 1 week back, followed by vesicle formation and ulcerations on lips. Oral lesions appeared first followed by dermal lesions. Oral lesions were associated with pain which was moderate and intermittent in nature and aggravated on mastication.

Past medical history revealed similar attack 3 months back. The patient reported no prolonged drug intake and hospitalization, and her family and drug history were noncontributory, with all her vital signs being within normal range.

Extraoral examination revealed multiple fluid-filled vesicles on right elbow with central crustation. Both right and left cervical lymph nodes were palpable, tender and soft to firm in consistency. On intraoral examination, multiple diffuse ulcerations of upper and lower labial mucosa were present. Swelling of upper and lower lips, fissuring and cracking of right and left corners of mouth with hemorrhagic crests were also noted and were tender on palpation.

Serology tests confirmed that the patient was positive for HSV and there was fourfold rise in antibody titer. Depending on the history, clinical examination and laboratory investigations, we arrived at the diagnosis of recurrent herpes associated erythema multiforme (HAEM).

The patent was treated with a 7-day course of acyclovir (1000 mg/day), a topical dexamethasone elixir and acetaminophen. Within a week, the oral lesions healed and skin lesions healed with transitory hyperpigmentation.

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