Post nirmatrelvir/ritonavir erythema multiforme in a patient with coronavirus disease infection

Abstract

Erythema multiforme (EM), an immune-mediated skin condition, can occur after infection or following the use of medications. In this study, we describe a patient who developed EM after nirmatrelvir/ritonavir administration. An 81-year-old woman presented with fever and dyspnea. Laboratory investigations showed positive coronavirus disease (COVID-19) based on polymerase chain reaction assay, and she received a 5-day regimen of nirmatrelvir/ritonavir. We observed development of EM after this treatment and initiated prednisone (1 mg/kg) therapy, which led to rapid improvement. Our study is the first to report EM in a patient with COVID-19, who received nirmatrelvir/ ritonavir and showed a favorable response.

Erythema Multiforme in an HIV+ Patient on Highly Active Antiretroviral Therapy After Starting Paxlovid (Nirmatrelvir-Ritonivir)

“…To date, there have been several adverse cutaneous manifestations of this drug that have been documented, including maculopapular rash, hyperkeratosis, hyperhidrosis, pruritus, skin edema, skin exfoliation, and alopecia [ 8 ]. However, there have been very few reports documenting the development of EM related to the use of this medication, especially due to drug interactions [ 9 ]. Conversely, EM has been documented as a side effect of other possible COVID-19 treatments, such as hydroxychloroquine and lopinavir-ritonavir [ 10 - 12 ].…”