Herpes simplex 1 associated with adult Erythema multiforme major

Abstract

Rashes in adults are one of the major diagnostic challenges.
We present the case of a woman with 68 years with chronic
diarrhea under study for 2 years and currently under a therapeutic trial with ciprofloxacin and metronidazole for bowel
excessive bacterial growth syndrome. Admitted in the ER with
generalized rash compatible with major erythema multiforme
(EM) associated with high fever (40ºC) and sphingo-thermal
dissociation with three days of evolution. Given the drug exposure and typical lesions of EM, it appeared intuitive to assume
a toxidermia but the complaints persisted. A review of the
physical examination revealed herpetiform vesicular lesions on
the hard palate hidden by the dental prosthesis. The diagnosis
of major EM to Herpes simplex type 1 was then confirmed by
Polymerase chain reaction of the vesicles and biopsy. After
systemic treatment with acyclovir for 5 days there was rapid
resolution of fever and total regression of lesions.