Oral erythema multiforme attributed to herpes simplex virus: A less recognized variant

Oral Erythema Multiforme (EM) is considered rare and less described variant in the world of EM. Examination of oral cavity lesions poses various diagnostic challenges and thus a thorough examination with history can help to reach a diagnosis. Due to possibility of subsequent severe attacks of EM, it has to be identified early in the course for better outcome of the patient.

Erythema multiforme is an intriguing clinical entity characterized by acute, self-limiting mucocutaneous hypersensitivity reactions. It can occur due to various etiological factors including infections, medications, autoimmune diseases, and malignancies; herpes simplex being the most common infection accounting for almost 90 percent of the overall cases. Here, we report a case of EM in an 8-year-old female child. The patient presented with an acute onset of crusting ulcers in the lips and oral cavity along with sparse cutaneous lesions around the lips. Based upon the patient's detailed history of prodromal symptoms, disease course and progression, careful clinical examination of wound and serology test, herpes simplex virus-associated erythema multiforme (HAEM) was diagnosed ruling out other mucocutaneous diseases, such as pemphigus, paraneoplastic pemphigus, mucous membrane pemphigoid, and lichen planus. The patient was admitted and treated for HAEM. To conclude, a detail clinical history and thorough clinical examination suggested the diagnosis of EM followed by serology tests to confirm the HSV1 association where proper medicament with supportive care led to an uneventful management.