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Images in Dermatology
November 21, 2018

Herpes-Associated Erythema Multiforme

Author Affiliations
  • 1Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
  • 2Department of Dermatology, University of Washington, Seattle, Washington
  • 3Deputy Editor, JAMA Dermatology
JAMA Dermatol. Published online November 21, 2018. doi:10.1001/jamadermatol.2018.3973

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.

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