A clinical case of erythema multiforme in pediatric patient

Abstract

Introduction: Previously healthy 8-year-old boy presented to the emergency department with a itchy maculopapular rash which later developed into target lesions with progression predominantly in his face, limbs, palms and soles. Right leg was swollen. No rashes on the mouth and genitals. Patient had febrile fever for a few days every 12 hours. One week before he played golf on the artificial grass, probably he had an unknown sting bite on his right shin a day before the rash as well. He had no allergies up to now, no history of chronic diseases. Methods: –. Results: Lab. tests: CRP 28 - > 5 mg/L, (slightly elevated, then normal), blood count – eosinophilia (abs. count 3,7 x 10^9/l), ASO titer 559kU/l—(elevated), strep test—positive, Respiratory Viral Panel (DNA)—Parainfluenza A virus, Parainfluenza B virus, Metapneumovirus,Adenovirus, Coronavirus HKU-1, Rhinovirus, Bocavirus, Parainfluenza 1 virus, Parainfluenza 2 virus, Parainfluenza 3 virus, Parainfluenza 4 virus, Respiratory syncytial virus A/B, Coronavirus NL63, Coronavirus 229E, Coronavirus OC43, Enterovirus—notfound. Liver enzymes, electrolites levels without changes, HSVIgM, IgG—negative, CMV IgM, IgG – negative, EBV IgG, IgM negative, Imunoglobuline E—625 kU/l—elevated. Blood, urine and tonsills swab test—negative, SARS CoV-2 infection antibodies—notfound. Radiologic tests: Ultrasound of left knee—oedemous soft tissues, small streak of liquid. Ultrasound of heart—without changes.Ultrasound of internal organs—without changes.Diagnosis: Idiopathic erythema multiforme minor.Discussion. Erythema multiforme (EM) first described in literature in 1886. It is uncommon inflammatory skin disease which has a pathognomonic sign—target lesion, sometimes oral or other mucosal involvement. This disease affects all age groups, 20% patients are kids,males are a bit more common than females. Etiology—in most cases are unknown, also can be caused by viruses (HSV1, HSV2, CMV,etc.), atypical infections (Mycoplasma pneumonia, Streptococcus,etc.), medications. There are a few cases that EM was caused by a spider-bite. Conclusions: In this case the cause is unknown, but the main triggers could be – Streptococcal infection (Elevated ASO titer, positive Strep test), insect bite or some allergens due to artificial grass. Table of classification of erythema multiforme. [...].