A woman in her 70s presented to the emergency department (ED) for evaluation and treatment of multiple target lesions. She had a history of recurrent herpes simplex virus (HSV) lesions on the left lower back, with an outbreak 3 weeks prior to presentation. Approximately 1 week before presenting to the ED, she developed tender red plaques on the right buttock (Figure). The main lesion had multiple concentric rings of varying degrees of inflammation, with a central bulla that eroded. Examination findings at the time of presentation were also notable for a crusted herpetiform eruption on the left upper buttock, consistent with her recent HSV outbreak. Direct fluorescent antigen testing of these herpetic lesions confirmed HSV infection, and a punch biopsy of the target lesion demonstrated interface dermatitis consistent with erythema multiforme. A diagnosis of herpes-associated erythema multiforme (HAEM) was made and the patient improved with a course of valacyclovir treatment.
Hashemi DA, Carlos C, Rosenbach M. Herpes-Associated Erythema Multiforme. JAMA Dermatol. Published online November 21, 2018. doi:10.1001/jamadermatol.2018.3973
Customize your JAMA Network experience by selecting one or more topics from the list below.
Create a personal account or sign in to: