Letters to the editor

We wish to bring to your attention a case of a 10-year-old male who was admitted with a 5-day history of pyrexia, cough/cold symptoms and severe oropharyngeal blistering causing trismus and odynophagia (Figures 1 and 2). Additionally, this young boy also presented with bilateral conjunctivitis as well as ‘target’ skin lesions on the nose, chest, back and anogenital region. A working diagnosis of erythema multiforme major was formulated.

A multidisciplinary team including paediatrics, maxillofacial surgery, dermatology, ophthalmology and dietetics managed this young patient. Administration of intravenous fluids, antimicrobials, systemic as well as topical steroids and eventual nasogastric feeding due to reduced oral intake was necessary due to the severity of his symptoms. He stayed in hospital for 17 days and was discharged after improvement in symptoms and oral intake.

Erythema multiforme (EM) manifests as a rapid onset maculo-papular rash or ‘target lesions’ of the skin.¹ Distinction is made between the cutaneous EM minor and the more severe EM major due to blistering/ulceration of two or more mucous membranes in the latter.² Distinction from the severe and life-threatening Steven–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is necessary at an early stage to tailor the management. Similarly, pemphigus and pemphigoid, which are both autoimmune blistering diseases, present with oro-cutaneous manifestations.³ These conditions have similar features, often causing a diagnostic conundrum.