多形性红斑(EMM)是一种罕见的IV型细胞毒性反应,靶向粘膜表面和真皮的角质形成细胞。Dusky,典型地存在有中央清除的类靶病变,可能会起泡和破裂。该疾病通常是自我限制的,并通过支持性护理和潜在疾病的治疗来管理。最常见的触发因素是药物不良反应,单纯疱疹病毒(HSV),和肺炎支原体。快速识别EMM对于避免长期并发症至关重要。该病例为一名39岁男性,近期使用非甾体类抗炎药(NSAID),既往感染HSV-1和急性肺炎支原体感染。病人皮肤出现了疼痛的损伤,口腔粘膜,眼表,还有尿道.疼痛性病变引起进食和排尿并发症。最初,触发事件尚不清楚.开始了支持性护理。停用NSAIDs,并避免使用类似结构的药物。针对肺炎支原体和HSV-1的治疗在实验室结果待定时开始。一旦结果返回,糖皮质激素治疗炎症的治疗方案,继续使用阿昔洛韦治疗HSV-1,阿奇霉素治疗肺炎支原体.将凡士林应用于开放性病变。患者也用由氢氧化铝(Al)/氢氧化镁(Mg)/西甲硅油(400mg/400mg/40mg)组成的漱口水治疗。使用带有涂药器的局部2%利多卡因凝胶来辅助排尿期间的泌尿不适。芬太尼用于疼痛控制。患者成功康复,出院后接受眼科随访。长期后遗症,包括倒车灯,symblepharon,随访期间发现泪点狭窄.
Erythema multiforme major (EMM) is a rare type IV cytotoxic reaction targeting keratinocytes of the mucosal surfaces and the dermis. Dusky, targetoid lesions with central clearing are classically present, which may become blistered and rupture. The disease is usually self-limited and managed with supportive care and treatment of the underlying condition. The most common triggering factors are adverse reactions to medications, herpes simplex virus (HSV), and Mycoplasma pneumoniae. Rapid recognition of EMM is essential to avoid long-term complications. This
case presents a 39-year-old male with a unique history of recent non-steroidal anti-inflammatory drug (NSAID) use, past infection with HSV-1, and an acute Mycoplasma pneumoniae infection. The patient developed painful lesions on the skin, oral mucosa, ocular surfaces, and urethra. The painful lesions caused complications with feeding and voiding. Initially, the triggering event was unclear. Supportive care was started. NSAIDs were discontinued and similarly-structured drugs were avoided. Treatments targeting Mycoplasma pneumoniae and HSV-1 were initiated while lab results were pending. Once the results returned, the treatment regimen of corticosteroids for inflammation, acyclovir for HSV-1, and azithromycin for Mycoplasma pneumoniae was continued. Vaseline was applied to open lesions. The patient was also treated with mouthwash consisting of aluminum (Al) hydroxide/magnesium (Mg) hydroxide/simethicone (400 mg/400 mg/40 mg). Topical 2% lidocaine gel with applicator was used to assist with urinary discomfort during voiding. Fentanyl was used for pain control. The patient successfully recovered and was discharged to follow-up with ophthalmology. Long-term sequelae including trichiasis, symblepharon, and punctal stenosis were noted during follow-up appointments.