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Precipitants in 42 cases of erythema multiforme
R M Villiger1, R O von Vigier, G P Ramelli
1Department of Paediatrics, Inselspital, University of Bern, CH-3010 Bern, Switzerland.
Insights
Infections triggered erythema multiforme in most pediatric cases, with Mycoplasma pneumoniae being a common cause. Medications also played a role in some children
Area of Science:
- Pediatrics
- Dermatology
- Infectious Diseases
Background:
- Erythema multiforme is an acute, self-limited skin reaction.
- Identifying triggers is crucial for understanding and managing the condition in children.
Purpose of the Study:
- To investigate the precipitating agents of erythema multiforme in pediatric patients.
- To determine the relative contribution of infections and medications to erythema multiforme development.
Main Methods:
- Retrospective analysis of 42 pediatric patients diagnosed with erythema multiforme.
- Review of medical records to identify antecedent infections, medications, or immunizations.
Main Results:
- Infections were identified as triggers in 71% of cases, including Mycoplasma pneumoniae (14 cases), upper respiratory tract disease (10 cases), and herpes simplex (6 cases).
- Medications were implicated in 10% of cases, with a presumptive role in an additional 29%.
- No precipitating agent was identified in 19% of patients.
Conclusions:
- Infections are the primary identified trigger for erythema multiforme in children.
- Medications and immunizations represent a significant, though less frequent, cause.
- Further investigation is needed for cases with unidentified precipitating agents.
Unlabelled:
A total of 42 children with erythema multiforme (aged 0.1 to 15.8 years, median 6.1 years) were treated between 1978 and 1997 at the Department of Paediatrics, University of Bern, Switzerland. Antecedent infections were noted in 30 cases: Mycoplasma pneumoniae infection (n = 14), acute upper respiratory tract disease (n = 10) and herpes simplex infection (n = 6). Four cases were associated with antecedent medication (n = 3) or immunization (n = 1). In 12 of the 30 patients in whom erythema multiforme followed an infectious disease, drugs described in the literature as inducers of erythema multiforme had been given for symptoms not suggestive of the condition. In the remaining eight children no precipitating agent could be detected.
Conclusion:
In this survey infections were found as a definite or at least presumptive trigger of erythema multiforme in 71% of cases. Drugs (including immunization) implicated as triggers of erythema multiforme played a definite causative role in 10% and a presumptive role in a further 29% of patients. In 19% of patients an associated condition was not diagnosed.