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Related Experiment Video

Updated: Dec 18, 2025

Ex Vivo Organotypic Corneal Model of Acute Epithelial Herpes Simplex Virus Type I Infection
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Ex Vivo Organotypic Corneal Model of Acute Epithelial Herpes Simplex Virus Type I Infection

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Herpes associated erythema multiforme: A retrospective study.

Michelle Hao1, Peter Zang1, Melanie Miller1

  • 1University of Southern California Keck School of Medicine, Department of Dermatology, United States of America.

The American Journal of Emergency Medicine
|June 11, 2020
PubMed
Summary

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Erythema multiforme (EM) diagnosis and workup were reviewed. Herpes simplex virus (HSV) testing is recommended for EM patients to guide treatment and prevent misdiagnosis.

Area of Science:

  • Dermatology
  • Infectious Diseases
  • Emergency Medicine

Background:

  • Erythema multiforme (EM) is an acute skin condition often seen in emergency departments.
  • EM classically presents with a targetoid rash.
  • This study reviewed EM cases to determine the proportion of Herpes-associated EM (HAEM) and inform diagnostic strategies.

Purpose of the Study:

  • To ascertain the proportion of Herpes-associated EM (HAEM) cases.
  • To inform the diagnostic workup for patients presenting with EM.
  • To identify common etiologies of EM in pediatric and adult populations.

Main Methods:

  • Retrospective review of EM cases at LAC-USC County Hospital from 2013-2019 using ICD-9 and ICD-10 codes.
  • Two abstractors screened records for EM diagnosis confirmation and data collection.
Keywords:
Erythema multiformeHerpes simplex virusMucositisMycoplasma pneumoniae

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  • Cohen's kappa statistic was used to ensure inter-rater reliability, achieving values from 0.803 to 1.0.

    • Main Results:

    • The study included 70 pediatric and 56 adult EM patients.
    • A likely etiology was identified in 63% of cases.
    • In pediatric EM, common causes included upper respiratory infection (URI) (33%) and Mycoplasma pneumoniae (7%). Adult EM was frequently linked to HSV infection (20%) and medications (9%).

    Conclusions:

    • Herpes simplex virus (HSV)-1/2 serologic testing is recommended for most EM patients to potentially avoid recurrent emergency department visits.
    • For EM cases not clearly linked to herpes or drug exposure, further workup like Mycoplasma serology, nasal PCR, or respiratory viral panel in pediatric patients is suggested.
    • Identifying the cause of EM can lead to different treatment approaches and prevent mislabeling of medication allergies.