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Minimal Erythema Dose MED Testing
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Nimesulide-induced Erythema Multiforme Major: A Case Report
Agnimshwor Dahal1, Prakash Dhungel2, Astha Thapa3
1Nepal Intensive Care Research Foundation, Kathmandu, Nepal.
JNMA; Journal of the Nepal Medical Association
|July 14, 2025
Summary
Erythema Multiforme Major (EMM) is a rare skin reaction. This case highlights nimesulide, a non-steroidal anti-inflammatory drug (NSAID), as a potential trigger for severe EMM, emphasizing prompt drug withdrawal.
Area of Science:
- Dermatology
- Pharmacology
- Toxicology
Background:
- Erythema Multiforme Major (EMM) is a rare, severe hypersensitivity reaction affecting skin and mucous membranes.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for pain and inflammation.
- Identifying specific drug triggers for EMM is crucial for patient safety.
Observation:
- A patient presented with severe EMM lesions following the ingestion of nimesulide.
- Nimesulide was prescribed for abdominal discomfort.
- The patient required hospitalization and supportive care.
Findings:
- This case report is the first to suggest nimesulide as a potential causative agent for EMM.
- Discontinuation of nimesulide and supportive management led to patient improvement.
- The reaction underscores the potential for NSAIDs to induce severe mucocutaneous reactions.
Implications:
- Clinicians should consider nimesulide in the differential diagnosis of drug-induced EMM.
- Increased awareness of nimesulide-associated EMM is needed among healthcare professionals.
- Prompt recognition and withdrawal of the offending drug are vital for managing EMM.
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