Erythema Multiforme-Like Presentation in an Asymptomatic COVID-19 Patient

Abstract

In clinical practice, there are a lot of variations in disease manifestations. Diseases are constantly evolving, and one negative test cannot completely rule out a disease. Erythema multiforme (EM) is a common mucocutaneous disease that can be linked to a lot of etiologies, with the most common being herpes simplex virus (HSV) types 1 and 2, Mycoplasma pneumoniae, and the use of various drugs. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new virus, and traditionally it is not the first differential for EM eruptions. We report the case of a 52-year-old female patient with a history of multiple drug use, pneumonia-like symptoms, an initial negative viral panel for SARS-CoV-2, followed by a positive polymerase chain reaction (PCR) test, asymptomatic coronavirus disease 2019 (COVID-19) clinical course, and break-out of typical targetoid lesions of EM. Throughout her hospital stay, the patient maintained her oxygenation levels and improved clinically with steroids and symptomatic treatment. She regained her health and was counseled to quit smoking, alcohol, and opioid usage at the time of discharge from the hospital, and a regular follow-up with her primary care practitioner (PCP) was advised.

Erythema Multiforme and COVID-19: A Case Report and Deep Insight

“…In 90% of cases, EM is linked to infectious pathogens, while drug-related EM is recorded in less than 10% of cases. The main agents are herpes simplex virus and Mycoplasma pneumoniae, but additional viruses such as adenovirus, coxsackievirus, and parvovirus B19 have also been reported [6].…”

“…A clear core is surrounded by a blister and a red perimeter in typical EM skin lesions. These lesions give an unpleasant burning feeling rather than pruritus [6].…”

Erythema Multiforme as Early Manifestation of COVID-19: A Case Report

“…EM is linked to infective agents, and the Herpes Simplex virus and Mycoplasma pneumoniae are the main agents [13]. Therefore, EM-like eruptions, associated with COVID-19 infection, were classified into three patterns [14]: (1) the virus-related juvenile type, referring to patients aged less than 30 years; (2) the virus-related older type referring to patients older than 55 years; and (3) the drug-induced type. The presented case may belong to the first model.…”