HLA-B15 association with erythema multiforme

Occurrence of erythema multiforme following COVID-19 vaccination: a review

The fast development of vaccines against the novel coronavirus disease is among the most critical steps taken to control this potentially fatal viral disease. Like other vaccines, the coronavirus disease 2019 (COVID-19) vaccines can also cause unwanted reactions. Erythema multiforme (EM) is among the oral mucocutaneous side effects of COVID-19 vaccines. This study aimed to comprehensively review the reported cases of EM since the global onset of COVID-19 vaccination. Data from 31 relevant studies regarding the type and dose of COVID-19 vaccines administered, time of initiation of symptoms, age, and gender of patients, site of involvement, patients' medical history, and treatment options were extracted. In total, 90 patients were identified with EM as a side effect of COVID-19 vaccination across studies. EM had the highest frequency after receiving the first dose of mRNA vaccines in older individuals. The first symptoms of EM appeared in less than 3 days in 45% and after 3 days in 55% of patients. EM is not a common side effect of COVID-19 vaccination, and fear of its occurrence should not impede vaccination.

Reticular Erythematous Mucinosis Occurring in a Brother and Sister

Reticular erythematous mucinosis (REM) is a rare, primary cutaneous mucinosis clinically characterized by a persistent reticular erythema on the mid chest and mid-upper back, and histologically by a mononuclear cell infiltrate and deposits of mucin in the dermis. To our knowledge, the present report of REM occurring in a Caucasian man and his sister is the first reported case of familial REM. Since a host-specific immune response to unknown antigens may be involved in the pathogenesis of this entity, human leukocyte antigen typing was determined and compared to those reported in autoimmune diseases.

Disseminated granuloma annulare following erythema multiforme minor

A 44-year-old woman presented with erythema multiforme minor followed by disseminated granuloma annulare 4 weeks later. The patient was not taking any medication and had no history of herpes simplex infection. Involvement of a delayed-type hypersensitivity reaction in the pathogenesis of these two well known disorders, as suggested by immunological investigations, may explain their concurrence in our patient. The substitution of the erythema multiforme minor lesions by an eruption of disseminated granuloma annulare at the same sites suggests the possibility of a Koebner phenomenon or an isotopic response.

Recurrent erythema multiforme: tissue typing in a large series of patients

Previous reports have shown an increased frequency of certain HLA antigens in association with erythema multiforme, including HLA-B15(B62), HLA-B35, HLA-A33, HLA-DR53 and, more recently, HLA-DQB1*0301. A strong association with HLA-DQ3 has been documented in patients with recurrent erythema multiforme. We have performed HLA typing in 39 patients with recurrent erythema multiforme, of whom 33 were associated with herpes simplex virus infection. The results were compared with 309 controls. In the recurrent erythema multiforme patients there was a statistically significant increase in HLA-B62 and HLA-B35. An increase in HLA-DR53 was also found, although this did not reach statistical significance. There was no increase in HLA-A33. The presence of HLA-DQ3 in the study population approached that in the controls. Finally, the study population demonstrated a trend towards a reduction in the HLA antigens A1, B8 and DR3. The study confirms the previously reported associations with HLA-B62 (B15), HLA-B35 and HLA-DR53. We have been unable to confirm an association of HLA-A33 or HLA-DQ3 with erythema multiforme. The HLA antigens A1, B8, and DR3 are associated with autoimmune disease, reflecting an increased host response to tissue self antigens. Their absence in patients with recurrent erythema multiforme (REM) may be an indicator of a poor host response to an antigen, which in the case of REM is the herpes simplex virus.

Are viruses associated with aphthae and oral vesiculo-erosive disorders?

Oral and maxillofacial surgeons in District General Hospitals in UK often carry the major workload of patients with chronic oral ulcerative conditions. Although the immunopathogenic basis of many of these is being unravelled, the aetiology is often unclear, though a role for viruses is increasingly suspected. This paper reviews the current evidence.

High-molecular-weight kininogen is cleaved in active erythema multiforme

Erythema multiforme (EM) is an inflammatory disorder of the skin, which may include mucous membrane involvement, that features target (iris) lesions. Mediators specifically involved in EM are not well characterized; its pathogenesis remains enigmatic. In this study, evidence for participation of kinins in the pathophysiology of inflammation in EM was investigated by assessing cleavage of high-molecular-weight kininogen (HMWK) in plasma. These data were compared with analyses of plasmas from patients with serum sickness, chronic idiopathic urticaria/angioedema, and from normal control subjects. Patients with EM demonstrated significant levels of circulating cleaved HMWK in plasma during active disease (p less than 0.01), which declined during remission/recovery. Plasmas from patients with EM obtained during active disease also demonstrated significant levels of 94 kd C1 inhibitor (p less than 0.01) and C1 inhibitor-kallikrein complexes. Patients with serum sickness and chronic idiopathic urticaria/angioedema did not demonstrate these findings and did not differ from normal control subjects (p = not significant). Although the kininogenase responsible for HMWK cleavage in EM has not been conclusively demonstrated, these findings suggest that HMWK cleavage resulted from activation of the contact system and that some of the manifestations of EM in selected patients may in part be accounted for by inflammatory and proinflammatory actions of kinins. Based on these preliminary findings, it will be important to establish whether or not HMWK cleavage in EM is a general finding in patients with this disorder. Further investigation is needed to characterize more clearly kininogenase activity and elucidate the possible role of kinin generation in EM.

Oral acyclovir for the prevention of herpes-associated erythema multiforme

Herpes simplex virus is the single most common precipitator of erythema multiforme. Typically, erythema multiforme lesions appear 10 to 14 days after a recurrent herpes simplex virus infection and attacks can be disabling when they occur at frequent intervals. Prior to the introduction of acyclovir (Zovirax), there was no effective therapy to prevent herpes-associated erythema multiforme. Four patients were treated with a maintenance dose of acyclovir for periods ranging from 10 to 26 months; there were no significant side effects from the drug and only one recurrence of erythema multiforme. Oral acyclovir may become the treatment of choice for herpes-associated erythema multiforme.