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A 26-year-old previously healthy man presented with a 1-month history of progressive mouth sores, eye discomfort, and skin rash. Over the 2 weeks before presentation, he had lost more than 10 kg (22 lb) because of difficulty in swallowing fluids and food, caused by the mouth sores. He had a history of herpes gladiatorum affecting his right shoulder. On physical examination, approximately 90% of his oral mucosa was ulcerated. Bilateral conjunctival hyperemia and targetoid skin macules involving his elbows, palms, upper thighs, and genitalia were observed (Figure 1). Results of 3 separate biopsies of the skin and mucosa were consistent with the clinical impression of erythema multiforme, showing scattered necrotic keratinocytes, basal cell liquefaction, subepidermal and intraepidermal edema, and a chronic inflammatory cell infiltrate (Figure 2). Three direct immunofluorescence studies showed intraepidermal cytoids and vascular staining, which were also consistent with erythema multiforme.
Davis MDP, Rogers III RS, Pittelkow MR. Recurrent Erythema Multiforme/Stevens-Johnson Syndrome: Response to Mycophenolate Mofetil. Arch Dermatol. 2002;138(12):1547–1550. doi:10.1001/archderm.138.12.1547
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