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Abstract: The patient, a 47-year-old male, presented to our hospital with multiple target-type erythema of the skin along with significant pruritus. He reported that he had been taking internal and external medications for nearly 2 weeks prior to the onset of the disease for treatment of cervical spondylosis. After combining the patient’s symptoms, medical history and various examinations, the patient was diagnosed with erythema multiforme, and the rash completely disappeared after 1 month of drug treatment as prescribed by the doctor, and the patient recovered his health.
Basic information】Male, 47 years old
Disease Type】Erythema multiforme
Hospital】Guangdong Provincial People’s Hospital
Date of consultation】November 2021
Treatment plan】Medication (injectable sodium methylprednisolone succinate + injectable sodium thiosulfate + Ebastine tablets + human blood gammaglobulin)
Treatment period】Hospitalization for 12 days, review after 2 weeks, six-month follow-up
Treatment effect】The rash completely disappeared, no recurrence
I. Initial consultation
The patient began to develop flaky erythema on the waist and extremities 2 weeks ago, with significant itching. He was diagnosed with contact dermatitis locally, but the treatment was not effective. On closer examination of the whole body, there were more coin-sized round crimson spots on the waist and extremities, with purplish-red deepening or even blistering in the center, resembling a target type in appearance, and the dense area of the rash had fused into a large crimson spot. There were no lesions in the eyes, mouth, or external genital area.
Auxiliary examination only showed a significant increase in blood eosinophil count, and there were no abnormalities in the blood, CRP, PCT and other infectious indicators, autoantibodies, herpes-like antibodies and herpes virus IgM antibodies. After in-depth questioning, the patient indicated that he had used a variety of homemade medications (specific details unknown) internally and externally for the treatment of cervical spondylosis at a local massage parlor 1 month ago and later developed a rash. Combined with the history of drug use and clinical manifestations, it was considered to be polymorphic erythema caused by drug allergy. After detailed communication about this condition, the patient underwent admission procedures.
II. Treatment history
After the patient was admitted to the hospital, the relevant examination was completed and contraindications such as infection and diabetes were excluded. On the 5th day of treatment, the patient’s condition became stagnant. After communicating with the patient about his condition and treatment plan, the dose of injectable sodium methylprednisolone succinate was increased and human gammaglobulin shock treatment was added for 3 days.
III. Treatment effect
On the 5th day of treatment, the pruritus was reduced and the erythema partially subsided, but there was a small amount of new erythema in the neighboring areas, so considering the large area of the rash and the seriousness of the patient’s condition, the medication was changed; on the 12th day of treatment, the erythema had mostly darkened and subsided, which met the discharge requirements and the patient was discharged. The patient’s erythema and pruritus disappeared completely, and the eosinophils returned to normal, and the biochemical indicators such as blood glucose and liver function were not abnormal, so all treatment drugs were discontinued. Six months later, the patient was followed up by telephone, indicating no recurrence of the disease.
IV. Caution
We are glad that the patient recovered after drug treatment. Since the patient’s disease was caused by drug allergy, he should avoid contact with suspected allergenic drugs again after discharge to avoid reoccurrence; pay attention to the protection of the lesion, avoid friction and injury, pay attention to personal hygiene, ensure that the affected area is dry and clean; also pay attention to the regular and quantitative medication as prescribed by the doctor, do not change the dosage or stop medication at will to avoid affecting recovery. Diet is recommended to be light and nutritious, which can provide nutritional support for body recovery.
V. Personal insight
The patient in this case is a typical erythema multiforme, with good symptoms after avoiding the cause and medication. Generally speaking, it is not difficult to make a clear diagnosis for those with typical erythema multiforme rash, which should be differentiated from frostbite, lupus erythematosus, herpetiform aspergillosis and syphilis. Some patients are prone to recurrence of the disease, so patient history should be taken to clarify the cause as much as possible, so as to treat the cause and avoid various triggering factors. Before treatment, we should improve relevant examinations and exclude contraindications to the use of glucocorticosteroids such as infections. During treatment, we should monitor changes in blood picture, blood pressure, blood glucose and other indicators and be alert to possible side effects of glucocorticosteroids.