Persistent erythema multiforme and CMV infection

Journal of Drugs in Dermatology, March, 2007 by Molly Wanner, Marlyanne Pol-Rodriguez, Ginette Hinds, Cheryl Hutt, Sameera Husain, Marc E. Grossman

Table 1. Cases of persistent erythema multiforme (EM).

Case                                Cause             Treatment

31-year-old female with a 15-month  EBV               Acyclovir
  history of EM
75-year-old male with a 4-month     Gastrointestinal  Resection tumor
  history of EM resistant to        adenocarcinoma
  prednisone (30 mg/day)
1 female patient (unknown age)      Unknown           Azathioprine
  with EM resistant to acyclovir*
1 female patient (unknown age)      Unknown           Azathioprine,
  with EM resistant to                                Steroids
  acyclovir ([double dagger])
1 female patient (unknown age)      Hormone           Oophorectomy and
  with EM resistant to acyclovir                      hysterectomy
  and resistant to azathioprine
  taper ([section])
41-year-old female with EM for 1    Ulcerative        Treatment of
  month                             colitis           ulcerative colitis
49-year-old female with EM for 6    Crohn's disease   Treatment of
  weeks                                               Crohn's disease
62-year-old female with a 2-month   Unknown           Azathioprine
  history of EM
37-year-old female with an 8-month  Unknown           Dapsone
  history of EM resistant to
  topical corticosteroids
65-year-old male with a 2-month     Influenza B       Etretinate
  history of EM resistant to
  topical corticosteroids and
  dapsone
39-year-old female with EM for 3    EBV               Thalidomide
  years resistant to steroid taper
44-year-old female with a 2-year    Unknown           Azathioprine
  history of EM resistent to
  prednisone taper
19-year-old (unknown sex) with a    Cryoglobulin      Azathioprine
  4-year history of EM resistant    associated
  to synacthen depot
80-year-old female with a 3-month   Unknown           Dapsone
  history of EM resistant to
  prednisolone taper
33-year-old male with a 5-month     HSV               Dapsone
  history of EM resistant to
  acyclovir and prednisolone
  (60 mg/day)
3 patients (unknown age, all        Immune complex    Gamma globulin
  female ([paragraph]))
29-year-old female with a 6-month   EBV               Acyclovir (#)
  history of EM resistant to IV
  betamethasone and potassium
  iodide
23-year-old male with EM for 18     HCV               Interferon alpha
  months
57-year-old male with a 1-month     Renal carcinoma   Resection tumor
  history of EM resistant to
  prednisone taper
61-year-old female with an 8-month  HSV               Dapsone
  history of EM resistant to
  prednisone taper
37-year-old with EM for 8 years     HCV               Interferon alpha
58-year-old female with EM for 3    CMV               Foscarnet
  months

Case                                Reference

31-year-old female with a 15-month   1
  history of EM
75-year-old male with a 4-month      1
  history of EM resistant to
  prednisone (30 mg/day)
1 female patient (unknown age)       2 ([dagger])
  with EM resistant to acyclovir*
1 female patient (unknown age)       2
  with EM resistant to
  acyclovir ([double dagger])
1 female patient (unknown age)       2
  with EM resistant to acyclovir
  and resistant to azathioprine
  taper ([section])
41-year-old female with EM for 1     3
  month
49-year-old female with EM for 6     3
  weeks
62-year-old female with a 2-month    4
  history of EM
37-year-old female with an 8-month   4
  history of EM resistant to
  topical corticosteroids
65-year-old male with a 2-month      4
  history of EM resistant to
  topical corticosteroids and
  dapsone
39-year-old female with EM for 3     5
  years resistant to steroid taper
44-year-old female with a 2-year     6
  history of EM resistent to
  prednisone taper
19-year-old (unknown sex) with a     6
  4-year history of EM resistant
  to synacthen depot
80-year-old female with a 3-month    7
  history of EM resistant to
  prednisolone taper
33-year-old male with a 5-month      8
  history of EM resistant to
  acyclovir and prednisolone
  (60 mg/day)
3 patients (unknown age, all         9
  female ([paragraph]))
29-year-old female with a 6-month   10
  history of EM resistant to IV
  betamethasone and potassium
  iodide
23-year-old male with EM for 18     11
  months
57-year-old male with a 1-month     12
  history of EM resistant to
  prednisone taper
61-year-old female with an 8-month  13
  history of EM resistant to
  prednisone taper
37-year-old with EM for 8 years     14
58-year-old female with EM for 3
  months

*This patient was responsive to Azathioprine for many years.
([dagger]) One of the patients with continuous EM cited in this paper
was excluded. Per Dr. Leigh, this patient was previously reported
(reference 9).
([double dagger]) As per a communication with Dr. Leigh, this patient
developed vasculitis. She was controlled on Azathiorpine, but became
intolerant and is now controlled on steroids.
([section]) The number of lesions in this patient appeared to be related
to menstruation according to Dr. Leigh. Her persistent EM resolved after
oophorectomy and hysterectomy.
([paragraph]) All patients were female as per communication with Dr.
Leigh.
(#) Patient was unable to taper acyclovir.