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Urticaria multiforme is an allergic hypersensitivity reaction. It manifests as a skin reaction with a vascular response pattern in the dermis. Urticaria multiforme is a benign, self-limited condition of unknown etiology, with onset in pediatric age and a more frequent range of presentation in children from 4 months to 4 years old. It is considered a subtype of urticaria in which the skin lesion corresponds to particular annular and polycyclic wheals, with a purple center and evanescent nature, frequently associated with acral edema and fever. The clinical recognition of urticaria multiforme, together with an adequate symptomatology, are sufficient for the diagnosis and provide peace of mind to parents. The most important differential diagnoses include acute urticaria, urticarial vasculitis, and erythema multiforme. The objectives of this article are to train pediatricians in recognizing urticaria multiforme and the differential diagnoses and to highlight the importance of symptomatology in reaching a diagnosis.
La urticaria multiforme representa una reacción de hipersensibilidad alérgica. Se manifiesta como una reacción cutánea con patrón de respuesta vascular a nivel de la dermis. Es una entidad de etiología desconocida, benigna y autolimitada, de aparición en edad pediátrica, con rango más frecuente de presentación en niños de 4 meses a 4 años. Se considera un subtipo de urticaria en donde la lesión dermatológica corresponde a particulares habones anulares y policíclicos, de centro violáceo y carácter evanescente, asociado con frecuencia a edema acral y fiebre. El reconocimiento clínico de esta entidad junto a una adecuada semiología son suficientes para el diagnóstico y brindar tranquilidad a los padres. Los diagnósticos diferenciales más importantes son la urticaria aguda, la urticaria-vasculitis y el eritema multiforme. Los objetivos de esta presentación son entrenar al pediatra para su reconocimiento, sus diagnósticos diferenciales y resaltar el valor de la semiología para alcanzar el diagnóstico.

UNASSIGNED: Oral Erythema Multiforme (EM) is considered rare and less described variant in the world of EM. Examination of oral cavity lesions poses various diagnostic challenges and thus a thorough examination with history can help to reach a diagnosis. Due to possibility of subsequent severe attacks of EM, it has to be identified early in the course for better outcome of the patient.
UNASSIGNED: Erythema multiforme is an intriguing clinical entity characterized by acute, self-limiting mucocutaneous hypersensitivity reactions. It can occur due to various etiological factors including infections, medications, autoimmune diseases, and malignancies; herpes simplex being the most common infection accounting for almost 90 percent of the overall cases. Here, we report a case of EM in an 8-year-old female child. The patient presented with an acute onset of crusting ulcers in the lips and oral cavity along with sparse cutaneous lesions around the lips. Based upon the patient\'s detailed history of prodromal symptoms, disease course and progression, careful clinical examination of wound and serology test, herpes simplex virus-associated erythema multiforme (HAEM) was diagnosed ruling out other mucocutaneous diseases, such as pemphigus, paraneoplastic pemphigus, mucous membrane pemphigoid, and lichen planus. The patient was admitted and treated for HAEM. To conclude, a detail clinical history and thorough clinical examination suggested the diagnosis of EM followed by serology tests to confirm the HSV1 association where proper medicament with supportive care led to an uneventful management.

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A unique dermatopathology incident arose after administration of the mRNA-1273 SARS-CoV-2 (Moderna) vaccine. Specifically, a transient purpuric interface dermatitis occurred 5 days post-second vaccine with the presentation of erythematous papules with erythema multiforme-type findings. A patient developed purpuric interface dermatitis with micro-vesiculation post-vaccination which ultimately resolved without sequelae.

Erythema multiforme (EM) is a delayed, cell-mediated cutaneous disease with varying clinical manifestations. It is most commonly associated with infections but can also be associated with medications, vaccines, and autoimmune diseases. Non-steroidal anti-inflammatory Drugs (NSAIDs) are commonly used analgesics that have rare associations with EM and pancytopenia. These adverse reactions to NSAIDs can obscure definitive diagnosis due to their rarity. We present a case where an elderly female patient taking 600mg of ibuprofen up to four times a day for shoulder bursitis developed EM and pancytopenia. In this case, a 75-year-old female with a medical history of atrial fibrillation, essential hypertension, non-insulin-dependent type 2 diabetes mellitus, and ischemic stroke with residual right-sided visual impairment presented to our Emergency Department in 2023 with neck swelling, skin rash, and ulceration of the oral cavity. She reported a generalized, targetoid body rash that occurred 15 days after she started taking ibuprofen regularly for left shoulder bursitis. No other medications were started before, after, or during this time period. CBC on admission was remarkable for a white blood cell count of 1.5x109/L, hemoglobin of 6.5 g/dL, and platelet count <10x109/L, consistent with pancytopenia. Ibuprofen was discontinued, and the patient was treated supportively with analgesia and packed red blood cell transfusions. Testing for HIV, antinuclear antibodies (ANA) panel, Hepatitis panel, and copper and zinc levels were negative. A biopsy of a targetoid lesion on the skin showed changes consistent with EM. Esophagogastroduodenoscopy revealed no actively bleeding lesions or ulcers in the stomach mucosa. The patient\'s blood counts eventually recovered with supportive treatment, and symptomatology improved. The patient was discharged six days after admission. Healthcare professionals should be aware of rare hematologic and immunologic side effects of NSAIDs, which may often be overlooked and misdiagnosed. More studies are needed to build on our wealth of knowledge regarding the etiology and management of EM, Steven Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN).

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A 14-year-old boy developed an erythema multiforme-like reaction following Toxicodendron radicans (poison ivy) allergic contact dermatitis three separate times over the course of 3 years. The severity of each erythema multiforme-like reaction corresponded to the severity of the allergic contact dermatitis which preceded it.

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