Erythema Multiforme

ERYTHEMA MULTIFORME

Q. 1

The most clinically significant skin eruption associated with M. pneumoniae infection is:

 A

Erythema multiforme major

 B

Bullous eruptions

 C

Toxic epidermal necrosis

 D

Pyostomatitis vegetans

Q. 1

The most clinically significant skin eruption associated with M. pneumoniae infection is:

 A

Erythema multiforme major

 B

Bullous eruptions

 C

Toxic epidermal necrosis

 D

Pyostomatitis vegetans

Ans. A

Explanation:

Erythema multiforme major (Stevens-Johnson syndrome) is the most clinically significant skin eruption associated with M. pneumoniae infection.

 
Ref:Harrisons Principles of Internal Medicine, 18th Edition, Page 1418

 


Q. 2

After taking sulphonamide group of drugs, one patient developed certain oral lesions. The lesions consist of vesicles, ruptured to form ulcers covered with pseudomembrane. While touching, the lesions bleed easily. Hemorrhagic crusts on lips and other skin lesions are also present.

Assertion: This is a case of erythema multiforme.
 
Reason: It is seen in immunocompromised patients and aggressive therapy with steroids is needed.
 
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 2

After taking sulphonamide group of drugs, one patient developed certain oral lesions. The lesions consist of vesicles, ruptured to form ulcers covered with pseudomembrane. While touching, the lesions bleed easily. Hemorrhagic crusts on lips and other skin lesions are also present.

Assertion: This is a case of erythema multiforme.
 
Reason: It is seen in immunocompromised patients and aggressive therapy with steroids is needed.
 
 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. C

Explanation:

Erythema multiforme is a disease of rapid onset involving the skin and mucous membranes.

It is associated with drug allergy or recent herpes simplex infection. Hemorrhagic crusts on the lips is a distinctive form.

The disease is self-limiting and management is mainly supportive. Steroids are used to treat the severe form.


Q. 3

Commonest etiology of erythema multiforme is –

 A

Viral

 B

Bacterial

 C

Food

 D

Drugs

Q. 3

Commonest etiology of erythema multiforme is –

 A

Viral

 B

Bacterial

 C

Food

 D

Drugs

Ans. A

Explanation:

A. i.e. Viral


Q. 4

Regarding Erythema multiforme all are true except:

 A

No vesicles

 B

Target lesions are seen

 C

Involves face and neck regions

 D

Sign of internal malignancy

Q. 4

Regarding Erythema multiforme all are true except:

 A

No vesicles

 B

Target lesions are seen

 C

Involves face and neck regions

 D

Sign of internal malignancy

Ans. A

Explanation:

A i.e. No vesicle

Erythema multiforme is caused mostly because of virus (herpes simplex virus 1(2) or rarely d/t drugs (sulfonamides mc) and internal malignancies Q. Characteristic target (iris/bull’s eye/annular) lesions is purpuric, erythematous-papulo-vesicular lesion resembling target of shooting range Q. It first appears acrally & then spread in a centripetal manner to symmetrically involve extensor surface of extremities (hand, feet, elbow, knee), face & neck Q. Mucosa is involved in 70% cases.


Q. 5

Which of the following is true about erythema multiforme:         

September 2011

 A

Triggered mainly by HIV infection

 B

Target lesions are seen

 C

Full blown prodromal symptoms

 D

Involvement of mucosa more common

Q. 5

Which of the following is true about erythema multiforme:         

September 2011

 A

Triggered mainly by HIV infection

 B

Target lesions are seen

 C

Full blown prodromal symptoms

 D

Involvement of mucosa more common

Ans. B

Explanation:

Ans. B: Target lesions are seen

Typical lesion of erythema multiforme is a target lesion, which consists of 3 concentric components 1) central dusky erythema, sometimes surmounted with a vesicle/ bulla, 2) pale edematous ring and 3) erythematous halo

“Erythema” in dermatology:

  • Erythema induratum: Bazins disease
  • Erythema nodosum: Multisystemic disorders e.g. sarcoidosis Erythema chronicum migrans: Lymes disease

Q. 6

Erythema multiforme ‑

 A

Staphylococcus

 B

TB

 C

HSV

 D

EBV

Q. 6

Erythema multiforme ‑

 A

Staphylococcus

 B

TB

 C

HSV

 D

EBV

Ans. C

Explanation:

Ans. is ‘c’ i.e., HSV

  • Idiopathic erythema multiforme is the most common cause of EM. o Herpes simplex is the most important infectious cause of EM.

Causes of Erythema multiforme

  • Idiopathic —> Most common cause
  • Viral –> HSV (most important) HBV, Mumps, Adenovirus o Bacteria -9 Streptococci, tuberculosis
  • Fungal –> Coccidioidomycosis, Histoplasmosis.
  • Drugs —-> Antibiotics (Sulphonamide), Phenytoin, NSAIDS. o Autoimmune disease –> SLE, thyroiditis, RA
  • Others —> Sarcoidosis, Pregnancy, Malignancy

Q. 7

Erythema multiforme is most commonly caused by‑

 A

Herpes simplex

 B

Idiopathic

 C

TB

 D

Drugs

Q. 7

Erythema multiforme is most commonly caused by‑

 A

Herpes simplex

 B

Idiopathic

 C

TB

 D

Drugs

Ans. B

Explanation:

Ans. is ‘b’ i.e., Idiopathic

  • Idiopathic erythema multiforme is the most common cause of EM.
  • Herpes simplex is the most important infectious cause of EM.

Causes of Erythema multiforme

  • Idiopathic —) Most common cause
  • Viral —> HSV (most important) HBV, Mumps, Adenovirus
  • Bacteria → Streptococci, tuberculosis
  • Fungal —> Coccidioidomycosis, Histoplasmosis.
  • Drugs —> Antibiotics (Sulphonamide), Phenytoin, NSAIDS.
  • Autoimmune disease —> SLE, thyroiditis, RA
  • Others —> Sarcoidosis, Pregnancy, Malignancy.


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