Erytheme Multiform

Question 1

What condition is this?

Answer 1

Erythema Multiforme

Question 2

What is the typical history with someone with erytheme multiforme?

Answer 2

They will usually have an URTI then start to develop a rash within 3 days. The rash will spread from the extremities to the trunk.

Question 3

What is the most common cause of Erytheme Multiform?

Answer 3

Herpes simplex virus

(50% of cases caused by HSV)

Question 4

What is the second most common cause of erythema multiforme?

Answer 4

Mycoplasma pneumoniae

Question 5

What are some viral causes of Erythema Multiforme?

Answer 5

• Herpes simplex (most common cause)
• Adenoviruses
• Influenza

Question 6

What are some bacterial causes of erythema multiforme?

Answer 6

• Pneumonia - mycoplasma pneumoniae (second most common cause), pneumococcus
• Syphilis
• Typhoid
• Streptococcus
• TB

Question 7

What are some non-cancerous diseases that cause erythema multiforme?

Answer 7

• Polycythaemia
• Connective Tissue Disease (e.g. SLE)
• Sarcoidosis
• Vasculitidies

Question 8

What malignancies can cause Erythema multiforme?

Answer 8

• Non-Hodgkin’s lymphoma
• Leukaemia
• Multiple myeloma

Question 9

What drugs can cause erythema multiforme?

Answer 9

• Sulphonamides
• Tetracyclines
• Amoxicillin & Ampicillin
• NSAIDs
• Anticonvulsants - carbemazepine
• COCP
• Allopurinol

Question 10

How do you treat Erythema Multiforme & what is its prognosis?

Answer 10

1. Stop offending drugs
2. Treat bacterial infections,
3. Give antivirals if recurrent HSV infections. Can give antiseptics to prevent secdonary infections.
4. If EM Major (Steve Johnsons Syndrome) then admit, get bloods, and give steroids.

• Prognosis- Usually resolves in 2-3 weeks in EM minor.
• EM Major takes 3-6 weeks to resolve.
• Mortality occurs in 5% of EM Major and usually correlates with increasing age, elevated blood urea and immune compromise.

Question 11

Answer 11

Question 12

Answer 12