Naslov
Consider subacute and systemic lupus erythematosus when dealing with typical presentation of erythema multiforme

Autori
Ferara, Nikola ; Špoljar, Sanja ; Culina, Lucija ; Haralović, Vanda ; Kuna, Matea

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, ostalo, stručni

Skup
EADV 31TH CONGRESS 2022

Mjesto i datum
Online ; Milano, Italija, 07.09.2022. - 10.09.2022

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
erythema multiforme like condition ; immune-mediated condition ; collagenosis

Sažetak
Erythema multiforme(EM) is an acute, usually self- limited, immune-mediated condition characterized by the appearance of distinctivetarget-likeskin lesion and often mucosal lesions, as well. Condition is in most cases induced by an infection, predominantly one with herpes simplex virus (90% of cases), although it can be associated with many different factors like medications, malignancy, autoimmune disease, vaccinations and other. Here wereportan unusual, yet instructivecase of a 54-year old female patient with skin lesions, initially suspected as dermatomycosis and EM. Initial skin lesion occurred as solitary, lightly erythematous macules on leftankle, inner side of left thigh and pectoral area, without itch or any other sensation. During thetwo following weeks lesions thickened and spread onto faceand back, with scaling and itch.Shortly after that patient noticed blister on her upper lip. In her firstvisit to dermatologist skin lesions clinically resembled dermatomycosis and patient was prescribred oral antifungal agent (terbinafin) solemnly based on clinical aspect, sincelaboratory testing on fungal infection was unavailableat thetime.She was also prescribed acyclovir dueto the blister on upper lip, suspected to be herpes simplex reactivation. However, patient quit using terbinafin after only few days dueto notion that it madeskin lesions worse. Also, dueto urinary infection symptoms and urinalysis (urineculture was not performed) patient was prescribed an antibiotic, sulfamethoxazole-trimethoprim combination, for ten days.Within the next two weeks lesions progressed (with appearance on palms and soles) and patient reported periodic chills and malaise. After another examination by a dermatologist patient was admitted in the dermatology inpatient department, with thefollowing aspect: typical target (central erythema, surrounded by a palering of edema and with erythematous halo) and targetoid lesions (central erythema regression with erythematous halo), 5 mm to 2 cm in size, distributed on trunk, faceand extremities.Lesions had slightly elevated rim with a trailing scale. Notable conditions from patient’s history are Hashimoto’s thyroiditis and GERD.Sheregularly takes only pantoprazoleand has no history of drug allergies.Shortly after admission a skin biopsy (from a trunk) with direct immunofluorescence(DIF) and extensive diagnostic test were performed, dueto theclinical suspicion of collagenosis - femalesex, ageand skin lesions that weresymmetrically distributed and on a photoexposed skin. Histopathological analysis showed interface dermatitis and DIF of affected skin revealed sparse granular C3 deposits at the dermoepidermal junction. Additional important findings: positive ANA (anti- nuclear antibody) test (>1:640) with positive Ro60 and Ro52 and positiveENA (extractable nuclear antigen). During her hospital stay patient was treated with oral corticosteroids (OCS) and was examined by a clinical immunologist, who introduced hydroxychloroquineand instructed further diagnostic tests (LAC and anti-dsDNA) and results arein making. After introduction of hydroxychloroquine, there has been improvement in skin lesions and dose of OCS has been gradually declined.Therefore, when dealing with EM - likelesion that havesymmetrical distribution on photoexposed skin, with additional risk factors, likesexand age, a physician should always suspect collagenosis.

Izvorni jezik
Engleski

Znanstvena područja
Dizajn, Biotehnologija u biomedicini (prirodno područje, biomedicina i zdravstvo, biotehničko područje)

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