Maria Lorna Frez M.D., Clinical Associate Professor
in Dermatology, University of the Philippines College of Medicine,
Philippines General Hospital, Manila, Phillipines on
September 20, 2007
Taking everything into consideration, I favor the diagnosis
of erythema multiforme over fixed drug eruption. The highly
pigmented character of the lesions may be due to the patient's
Indian race. To answer the question, there is a variant of FDE
called "wandering FDE" where recurrent lesions develop
on varying, instead of fixed location. The positive serology
for herpes simplex is compatible with EM.
David Elpern M.D. , Williamstown, Massachusetts, USA
on September 20, 2007
This is a difficult case. The clinical pictures are small --
we might benefit from having larger photos. In addition to what
was suggested, atypical erythema multiforme-like lesions have
been described in textile contact dermatitis. All of this child's
lesions (at least those described above) have occurred on areas
that are contacted by clothing -- so, this may need to be considered
in the differential diagnosis.
Lazarov A. Textile dermatitis in patients with contact sensitization
in Israel: a 4-year prospective study. J Eur Acad Dermatol Venereol.
2004 Sep;18(5):531-7.
Dermatology Clinic, Meir Hospital, 44281, Kfar Saba, affiliated
with the Sackler School of Medicine, Tel Aviv University, Israel.
lazarov1@netvision.net.il
Although chronic dermatitis was the typical clinical presentation,
less frequent forms such as purpuric, hyperpigmented and papulopustular
lesions and atypical forms such as erythema multiforme-like,
nummular-like lesions, lichenification and erythrodermia were
observed in 24.4% of the cases."
Khalid Al Aboud M.D., Medical Director, Makkah, Saudi
Arabia on September 20, 2007
There is no comments on blood vessels in the dermis. The presence
of neutrophils in the dermis may point to urticarial vasculitis.
However, the morphology of the lesion is only with fixed drug
eruption. Given the scenario that, it recurs with fever, it
might be related to antipyretics. Detailed history is needed
from the child and his parents.
Khalifa Sharquie MD, PhD, Professor, Baghdad, Iraq
on September 20, 2007
Whatever the history, the cilinical picture and histopathological
findings are that of FDE. Sometimes drugs in milk like sulfa
given to cows might be a cause even there is no history of drugs
intake.There is no relation to herpes simplex antibody titer
but fever and reaction of FDE might contibuted to rising antibody
in previously infected individual with herpes.
Ibrahim Misk M.D., Jordan. on September September
20, 2007
Clinically consistent with Fixed Drug Eruption but at the same
time I must respect the opinion of the histopathologist for
erythema multiforme.
Muhsin A. A. Aldhalimi MD, Head, Department of Dermatology,
College of Medicine, University of Kufa, Najaf, Iraq
on September 21, 2007
Thank you very much for this nice presentation. It rises again
the question of histological differentiation of EM, TEN and
FDE and whether they represent a spectrum of same disease or
they are separate entities. The histological findings cannot
differentiate definitely between the two differential diagnoses.
From clinical point of view, the diagnosis most probably fixed
drug eruption. We notice many patients with typical FDE lesions
who don't give positive drug history. The drug history in an
8-year old child cannot be excluded definitely. He may take
any simple drug from the home pharmacy without notice of the
parents or the drug taken with animal-origin foods that may
contain sulfa or tetracycline that are commonly used by veterinarians.
Bhushan Kumar MD, Former Head of Dermatology, Postgraduate
Institute of Medical Education & Research, Chandigarh, India
on September 22, 2007
Recurrent erythema multiforme due to recurrent herpes simplex
infection is a recognised entity. FDE lesions can occur at variable
sites but post inflammatory hyperpigmentation of the previous
lesions is always striking - which in this case is missing.
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