Epstein-Barr Virus/Cytomegalovirus-Associated Erythema Multiforme in a Pediatric Patient

Erythema multiforme (EM) is an immune-mediated mucocutaneous condition that presents with multiple, self-limited, target-shaped erosive/ulcerative lesions of the skin and/or mucosa. Approximately 20% of EM cases affect pediatric patients, with the oral mucosa being commonly involved. EM is typically preceded by infections, notably herpes simplex virus, and medication use. Although rare, Epstein-Barr virus (EBV) and cytomegalovirus (CMV) infections have also been reported. To the best of the authors' knowledge, EM associated with EBV and CMV (double positivity) has not been reported to date. This report presents the case of a healthy 10-year-old girl presenting with bleeding ulcers and coalescing vesicles in the perioral skin and oral mucosa. Although an adverse reaction to the local anesthetic, applied for the first time during dental care, was initially suspected, serological analysis strongly suggested EBV/CMV primary acute infection. After 2 weeks, following antiviral and steroid support, the lesions resolved completely.