Management of Herpes-Associated Erythema Multiforme in a Young Male: A Case Report

Authors

  • Fatimah F. Basalamah Universitas Airlangga
  • Gremita K. Dewi Universitas Airlangga
  • Diah S. Ernawati Universitas Airlangga
  • Nisa'a T. Fatarnaha Universitas Airlangga
  • Desiana Radithia Universitas Airlangga
  • Nurina F. Ayuningtyas Universitas Airlangga

DOI:

https://doi.org/10.35790/eg.v14i1.64361

Keywords:

herpes-associated erythema multiforme; herpes simplex virus infection; oral ulcer; acyclovir; supportive therapy

Abstract

Abstract: Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction often triggered by infections or medications. The most common infectious cause is herpes simplex virus (HSV). Herpes-associated erythema multiforme (HAEM) typically presents with sudden, painful oral ulcers and hemorrhagic crusts on the lips. This case report highlights the clinical presentation, diagnosis, and management of a young adult with HAEM. A 20-year-old male presented with multiple painful oral ulcers and lip crusting following a febrile episode. Clinical examination revealed multiple, variably sized ulcers with erythematous borders and yellowish centers. A diagnosis of HAEM was established based on clinical findings and serological tests showing reactive HSV-1 IgG. The patient was hospitalized due to severe pain, dehydration, and inability to eat. Treatment included systemic acyclovir, intravenous fluids, analgesics, and supportive topical therapy with aloe vera extract mouthwash for intraoral lesions and hydrocortisone ointment for lip crusts. The ulcers and pain progressively improved, with complete recovery achieved by the third follow-up visit. This case emphasizes the importance of timely recognition and combined systemic–topical therapy in HAEM. Early antiviral intervention with supportive care can prevent complications, restore nutritional intake, accelerate healing, and improve quality of life.

Keywords: herpes-associated erythema multiforme; herpes simplex virus infection; oral ulcer; acyclovir; supportive therapy

Author Biographies

Fatimah F. Basalamah, Universitas Airlangga

Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Gremita K. Dewi, Universitas Airlangga

Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Diah S. Ernawati, Universitas Airlangga

Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Oral Medicine Specialist, Rumah Sakit Universitas Airlangga, Surabaya, Indonesia

Nisa'a T. Fatarnaha, Universitas Airlangga

Oral Medicine Specialist Study Program, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

Desiana Radithia, Universitas Airlangga

Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya,  Indonesia

Nurina F. Ayuningtyas, Universitas Airlangga

Department of Oral Medicine, Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia

References

1. Glick M, Greenberg MS, Lockhart PB, Challacombe SJ. Burkets’s Oral Medicine (13th ed). USA: Wiley Blackwell; 2021.

2. Philipone E, Yoon AJ. Oral Pathology in the Pediatric Patient (1st ed). 2017. Doi: https://doi.org/10.1007/978-3-319-44640-0.

3. Trayes KP, Love G, Studdiford JS. Erythema multiforme: recognition and management. Am Fam Physician 2019;100(2):82–8. Available from: https://pubmed.ncbi.nlm.nih.gov/31305041/

4. Neville BW, Damm DD, Allen CM, Chi AC. Oral and Maxillofacial Pathology (4th ed). Canada: Elsevier; 2016.

5. Lucchese A. From HSV infection to erythema multiforme through autoimmune crossreactivity. Autoimmun Rev 2018;17(6):576–81. Doi: https://doi.org/10.1016/j.autrev.2017.12.009

6. Laskaris G. Pocket Atlas of Oral Diseases (3rd ed). Germany: Thieme; 2020.

7. Odell EW. Cawson’s Essentials of Oral Pathology and Oral Medicine (9th ed). London: Elsevier Ltd; 2017.

8. Mailiza F. Herpes associated erythema multiforme: case report. Odonto: Dental Journal 2022;9(S1):33. Doi: 10.30659/odj.9.0.33-39

9. Susanto H, Nurhilailah N, Ganesha R, Hendarti HT, Hadi P. Herpes-associated erythema multiforme in a postmenopausal woman. Majalah Kedokteran Gigi Indonesia 2022;7(1):51. Doi: https://doi.org/10.22146/ majkedgiind.43299

10. Muryah AE, Sufiawati I. Successful treatment of herpes simplex-associated erythema multiforme with a combination of acyclovir and prednisone. Journal of Dentomaxillofacial Science 2017;2(3):191. Doi: https://doi.org/10.15562/jdmfs.v2i3.484

11. Hao M, Zang P, Miller M, Cutler L, Worswick S. Herpes associated erythema multiforme: a retrospective study. Am J Emerg Med. 2020;38(2):2761.e1-2761.e3. Doi: 10.1016/j.ajem.2020.05.084

12. Rochmah YS, Mujayanto R. Herpes associated erithema multiforme (HAEM ) on the psychosomatis patient : a case report. Jurnal Medali 2021;3(1):51. Doi: https://doi.org/10.30659/medali.v3i1.17390

13. Thongprasom K. Treatment of a pregnant patient with herpes associated erythema multiforme (HAEM): a case report. Acta Stomatol Croat 2016;50(3):265–8. Doi: https://doi.org/10.15644/asc50/3/10

14. Thongprasom K, Sooampon S. Effectiveness of topical steroids in treating herpes-associated erythema multiforme and review of topical steroids erythema multiforme and review of topical St. Journal of Dentistry Indonesia 2019;26(2):114–8. Doi: https://doi.org/10.14693/jdi.v26i2.1342

15. Shinde SB, Lohe V, Mohod S. Herpes simplex virus (HSV)-induced erythema multiforme: a rare case report. Cureus 2024;16:1–5. Doi: https://doi.org/10.7759/cureus.62650

16. Alfar MY, Alrousan M AZ. The use of corticosteroids in management of herpes associated erythema multiforme. J Pak Med Assoc 2015;65(12):1351–3. Available from: pubmed.ncbi.nlm.nih.gov/26627523/

17. DeLong L, Burkhart N. General and Oral Pathology for the Dental Hygienist (2nd ed). Baltimore: Wolters Kluwer Health | Lippincott Williams & Wilkins; 2013.

18. Spencer S, Buhary T, Coulson I, Gayed S. Mucosal erosions as the presenting symptom in erythema multiforme: a case report. British Journal of General Practice 2016;66(664):e222–4. Doi: https://doi.org/10.3399/bjgp16X684205

19. Senger B, Memar SA, Ahmann A, Houser JJ, Doughty-McDonald L. Dermatologic and ophthalmologic treatment of erythema multiforme major: a case report. Cureus. 2021;13(12):e20854. Doi: https://doi.org/10.7759/cureus.20854

20. Mtiri A, Bouslama G, Ben Messouad N-S, Abidi I, Ben Youssef S, Sriha B. Erythema multiforme attributable to herpes simplex virus: clinical aspects and treatment. Case Rep Dent 2021;2021:6692495. Doi: https://doi.org/10.1155/2021/6692495

21. Piliang A, Nasution D, Hidayat W. Eritema multiforme terkait infeksi virus dan alergi: laporan kasus. B-Dent. 2022;9(1):44–52. Doi: https://doi.org/10.33854/jbd.v9i1.972

22. Ganesha R, Kartika Sari R. Treatment of herpes associated erythema multiforme (HAEM). Interdental Jurnal Kedokteran Gigi (IJKG) 2023;19(1):11–6. Doi: https://doi.org/10.46862/interdental.v19i1.6350

23. Poller WC, Downey J, Mooslechner AA, Khan N, Li L, Chan CT, et al. Brain motor and fear circuits regulate leukocytes during acute stress. Nature. 2022;607(7919(:578–84. Doi: https://doi.org/10.1038/s41586-022-04890-z

24. Hensel M, Grädel L, Kutz A, Haubitz S, Huber A, Mueller B, et al. Peripheral monocytosis as a predictive factor for adverse outcome in the emergency department. Medicine 2017;96(28):e7404. Doi: https://doi.org/10.1097/MD.0000000000007404

25. Ganesha R, Sari RK, Putra NGJ. Management of herpes labialis triggered by stress. Interdental Jurnal Kedokteran Gigi (IJKG) 2021;17(2):56–62. Doi: https://doi.org/10.46862/interdental.v17i2.2966

26. Akhmatova N, Masgutova S, Ekaterina S, Elvin A, Lebedinskaya OV. Influence of neuro-sensory-motor reflex integration technique on immune response of patients with herpes-associated multiforme erythema. Front Immunol 2015;6. Doi: https://doi.org/10.3389/conf.fimmu.2015.05.00075

27. Kite J, Russell T, Jones J, Elliott G. Cell-to-cell transmission of HSV1 in human keratinocytes in the absence of the major entry receptor, nectin1. PLoS Pathog 2021;17(9):e1009631. Doi: https://doi.org/10.1371/journal.ppat.1009631

28. Soares A, Sokumbi O. Recent updates in the treatment of erythema multiforme. Medicina (B Aires) 2021;57(9):921. Doi: https://doi.org/10.3390/medicina57090921

29. McClain L, Zhi Y, Cheng H, Ghosh A, Piazza P, Yee MB, et al. Broad-spectrum non-nucleoside inhibitors of human herpesviruses. Antiviral Res 2015;121:16–23. Doi: https://doi.org/10.1016/j.antiviral.2015.06.005

30. Shabani M, Nasr Esfahani B, Sadegh Ehdaei B, Moghim S, Mirzaei A, Sharifi M, et al. Inhibition of herpes simplex virus type 1 replication by novel hsa-miR-7704 in vitro. Res Pharm Sci. 2019;14(2):167. Doi: https://doi.org/10.4103/1735-5362.253364

31. Greive KA, Barnes TM. Increased bioavailability of hydrocortisone dissolved in a cream base. Australas J Dermatol 2015;56(2):e30–4. Doi: https://doi.org/10.1111/ajd.12128

32. Hussein WA, Zamil ST, Zamil ST, Hussain MA, Kadhim HA. Formulation design and evaluation of hydrocortisone gel for topical use. International Journal of Drug Delivery Technology 2022;12(03):1162–5. Doi: https://doi.org/10.25258/ijddt.12.3.39

33. Raditya INY, Ridia KGM, Aryana IGNW, Fatmawati NND, Suyasa IK. Differences in decreasing bacteria colonization wound irrigation using 0.9% NaCl compared with wound irrigation using active ingredients Polyhexanide 0.1% and 0.1% Betaine in open fractures of long bone. Open Access Maced J Med Sci. 2023;11(B):514–8. Doi: https://doi.org/10.3889/oamjms.2023.11599

34. Gallagher KE, Alberto EC, Mallow PJ, Hermans MH, Cardenas L. A retrospective health economic analysis of a stable hypochlorous acid preserved wound cleanser versus 0.9% saline solution as instillation for negative-pressure wound therapy in severe and infected wounds. Cureus. 2022;14(4):e24321. Doi: https://doi.org/10.7759/cureus.24321

35. Ankalikar A, Viswanathswamy AHM. Effect of Vitex trifolia linn and Solanum nigrum Linn on oxidative stress and inflammation. Indian Journal of Health Sciences and Biomedical Research (KLEU) 2017;10(3):269. Doi: https://doi.org/10.4103/kleuhsj.kleuhsj_11_17

36. Nugraha AP, Ernawati DS, Harijanti K, Parmadiati AE. Psychological stress induced xerostomia and hyposalivation: The case study in Indonesian female patient. Journal of International Dental and Medical Research 2019;12(1):216–9. Available from: https:// scholar.unair.ac.id/en/publications/psychological-stress-induced-xerostomia-and-hyposalivation-the-ca/

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Published

2025-11-05

How to Cite

Basalamah, F. F., Dewi, G. K., Ernawati, D. S., Fatarnaha, N. T., Radithia, D., & Ayuningtyas, N. F. (2025). Management of Herpes-Associated Erythema Multiforme in a Young Male: A Case Report. E-GiGi, 14(1), 190–197. https://doi.org/10.35790/eg.v14i1.64361

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