ERITEMA MULTIFORME PASCA-VARISELA
Kata Kunci:
asetaminofen, eritema multiforme, varisela
Abstrak
Eritema multiforme (EM) adalah erupsi kutan atau mukokutan yang jarang ditemukan, ditandai oleh lesi target. Eritema multiforme biasanya disebabkan oleh reaksi hipersensitivitas terhadap infeksi (misalnya varisela) dan obat-obatan (antara lain asetaminofen).
Pasien perempuan, 23 tahun, datang dengan lesi target khas EM. Keluhan didahului oleh varisela 6 hari sebelumnya. Lesi varisela mengering dengan terapi valasiklovir, asetaminofen, dan multivitamin. Pada hari ke-4 varisela timbul urtikaria dan pada hari ke-6 muncul lesi EM. Pemeriksaan darah lengkap dalam batas normal, kecuali eosinofil sedikit meningkat. Pasien didiagnosis sebagai EM minor akibat erupsi obat dengan diagnosis banding EM minor akibat varisela dan penyakit Degos. Perbaikan terjadi setelah terapi metilprednisolon, desloratadin, dan losio pelembap.
Eritema multiforme terjadi 6 hari sesudah pasien mengalami varisela dan mengonsumsi obat. Penyebab EM pada kasus ini diduga akibat obat karena lesi varisela membaik dengan terapi valasiklovir serta ada lesi urtikaria sebelum lesi target muncul. Di antara obat-obat yang digunakan pasien, asetaminofen diduga sebagai penyebabnya. Pemeriksaan serologis untuk varisela dan uji tempel atau provokasi oral untuk alergi obat perlu dipertimbangkan untuk menegakkan diagnosis pasti.
References
1. Roujeau J, Mockenhaupt M. Erythema multiforme. Dalam: Kang S, Amagai M, Bruckner AL, Enk AH, Margolis DJ, penyunting. Fitzpatrick’s Dermatology. Edisi ke-9. New York: Mc Graw Hill Education; 2019.h.723-32.
2. Prais D, Grisuru-Soen G, Barzilai A, Amir J. Varicella zoster virus infection associated with erythema multiforme in children. Infection. 2001;29:37-9.
3. Choy AC, Yarnold PR, Brown JE, Kayaloglou GT, Greenberger PA, Patterson R. Virus induced erythemamultiforme and Stevens-Johnson syndrome. Allergy Proc.
1995;16:157-61.
4. Choi HJ, Kim HO, Kim CW, Park YM. Bullous erythema
multiforme following herpes zoster. Ann Dermatol.
2003;15:116-8.
5. James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus
IM. Erythema and urticaria. Dalam: James WD, Elston DM, Treat JR, Rpsenbach MA, Neuhaus IM, penyunting. Andrews’ Diseases of the Skin. Edisi ke-13. Edinburgh: Elsevier; 2019.h.140-56.
6. Krishnankutty K, Chaudhuri K, Ashok L. Erythema multiforme: a case series and review of literature. J Trans Med Res. 2018;2:124-30.
7. Paulino L, Hamblin DJ, Osondu N, Amini R. Variants of erythema multiforme: a case report and literature review. Cureus. 2018;10:e3459-h.1-8.
8. Kamala KA, Ashok L, Annnigeri RG. Herpes associated erythema multiforme. Contemp Clin Dent. 2011;2:372-5.
9. Shah SN, Chauhan GR, Manjunatha BS, Dagrus K. Drug induced erythema multiforme: Two case series with review of literature. J Clin Diagnostic Res. 2014;8(9):ZH01-ZH04.
10. Kishore BN, Ankadavar NS, Kamath GH, Martis J. Varicella zoster with erythema multiforme in a young girl: a rare association. Indian J Dermatol. 2014;59:299-301.
11. Breathnach SM. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Dalam: Burns T, Breathnach S, Cox N, Griffiths C, penyunting. Rook’s Textbook of Dermatology. Edisi ke-8. West Sussex: Wiley- Blackwell; 2010:76.1-22.
12. New Zealand Medsafe. Serious skin reactions with paracetamol. Reactions. 2014;1506:2-3.
13. United States Food and Drug Administration. FDA Drug Safety Communication: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetami- nophen. FDA Drug Safety Communication 2013 [halaman dalam internet]. 2013. [Disitasi 25 Oktober 2019]. Diunduh dari:https://www.fda.gov/drugs/drug-safety-and- availability/fda-drug-safety-communication-fda-warns- rare-serious-skin-reactions-pain-relieverfever-reducer
14. Onishi I, Kishimoto S. Erythema multiforme after resolution of herpes zoster by acyclovir. Eur J Dermatol. 2002;12:370-2.
15. Wollina U, Gemmeke A. Herpes zoster - associated erythema multiforme. J Dermatol Case Rep. 2009;3:11-3.
16. Park IH, Kang JN, Seol JE, Sung HS, Kim H. A case of erythema multiforme followed by herpes zoster. Infection. 2014;42:799-800.
17. Hamm RL. Drug allergy: delayed cutaneous hypersensitivity reactions to drugs. EMJ Allergy Imunol. 2016;1:92-101.
18. Singh SK, Prabhu A, Kumar A. Valacyclovir- induced urticaria without acyclovir hypersensitivity. Ind J Dermatol Venereol Leprol. 2015;81:611-2.
19. Lee HJ, Kim JM, Kim GW, Mun JH, Song M, Kim HS, dkk. Fixed drug eruption due to acyclovir, valacyclovir and
famciclovir. JEADV. 2016;30:1417-9.
20. Ebo DG, Bridts CH, De Clerck LS, Stevens WJ. Immediate
allergy from valacyclovir. Allergy. 2008;63:941-2.
21. Daito J, Hanada K, Katoh N, Katoh S, Sakamoto K, Asai J, dkk. Symmetrical drug-related intertriginous and flexural exan-
thema caused by valacyclovir. Dermatology. 2009;218:60-2. 22. Zhang AJ, Warshaw EM. Allergic contact dermatitis caused by mupirocin and pimecrolimus. Contact
Dermatitis.2018;80;132-3.
23. Praz S-M, Torrente A de, Zender H, Schmied E, Schleppy
C-A, Genne D. Toxic epidermal necrolisis after topical intranasal application of mupirocin. Infect Control Hosp Epidemiol. 2003;24:459-60.
24. Blumenthal KG, Ziegler JB. Hypersensitivity reactions, dietary supplements, and the importance of the case report. J Allergy Clin Immunol Pr. 2016;4:177-8.
25. Keen MA, Hassan I. Vitamin E in dermatology. Indian Dermatol J. 2016;7:311-5.
26. Pastor-Nieto M-A, Gatica-Ortega M-E, Melgar-Molero V, Gonzalez-Munoz P, Mollejo M, Schoendorff C, dkk. Erythema multiforme-like reaction resulting from vitamin K1 oxide phytomenadione epoxide). Contact Dermatitis. 2017;77:325-6.
27. Özkaya E, Topkarci Z, Özarmaǧan G. Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet. Contact Dermatitis. 2010;62:184.
28. Oh SW, Lew W. Erythema multiforme induced by acetaminophen: a recurrence at distant sites following patch testing. Contact Dermatitis. 2005;53:56-7.
29. Ball E, Newburger A, Ackerman AB. Degos’ disease: A distinctive pattern of disease, chiefly of lupus erythematosus, and not a specific disease per se. Am J Dermatopathol. 2003;25:308-20.
30. Pirolla E, Fregni F, Miura IK, Misiara AC, Almeida F, Zanoni E. Degos disease - malignant atrophic papulosis or cutaneointestinal lethal syndrome: rarity of the disease. Clin Exp Gastroenterol. 2015;8:141-7.
31. Theodoridis A, Makrantonaki E, Zouboulis CC. Malignant atrophic papulosis (Kohlmeier-Degos disease) - a review. Orphanet J Rare Dis. 2013;8:10.
32. Kovalszki A, Weller PF. Eosinophilia. Prim Care. 2016;43:607-17.
33. Aisah S, Handoko RP. Varisela. Dalam: Menaldi SLS, Bramono K, Indriatmi W, penyunting. Ilmu Penyakit Kulit Dan Kelamin. Edisi ke-7. Jakarta: Badan Penerbit Fakultas Kedokteran Universitas Indonesia; 2018.h.128-31.
34. Bergendorff O, Hansson C. Urticaria and anaphylaxis to povi- done in a paracetamol preparation. JEADV. 2007;21:573-4.
35. Hill G, Chauvenet AR, Lovato J, McLean TW. Recent steroid therapy increases severity of varicella infections in children with acute lymphoblastic leukemia. Pediatrics. 2005;116:525-9.
2. Prais D, Grisuru-Soen G, Barzilai A, Amir J. Varicella zoster virus infection associated with erythema multiforme in children. Infection. 2001;29:37-9.
3. Choy AC, Yarnold PR, Brown JE, Kayaloglou GT, Greenberger PA, Patterson R. Virus induced erythemamultiforme and Stevens-Johnson syndrome. Allergy Proc.
1995;16:157-61.
4. Choi HJ, Kim HO, Kim CW, Park YM. Bullous erythema
multiforme following herpes zoster. Ann Dermatol.
2003;15:116-8.
5. James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus
IM. Erythema and urticaria. Dalam: James WD, Elston DM, Treat JR, Rpsenbach MA, Neuhaus IM, penyunting. Andrews’ Diseases of the Skin. Edisi ke-13. Edinburgh: Elsevier; 2019.h.140-56.
6. Krishnankutty K, Chaudhuri K, Ashok L. Erythema multiforme: a case series and review of literature. J Trans Med Res. 2018;2:124-30.
7. Paulino L, Hamblin DJ, Osondu N, Amini R. Variants of erythema multiforme: a case report and literature review. Cureus. 2018;10:e3459-h.1-8.
8. Kamala KA, Ashok L, Annnigeri RG. Herpes associated erythema multiforme. Contemp Clin Dent. 2011;2:372-5.
9. Shah SN, Chauhan GR, Manjunatha BS, Dagrus K. Drug induced erythema multiforme: Two case series with review of literature. J Clin Diagnostic Res. 2014;8(9):ZH01-ZH04.
10. Kishore BN, Ankadavar NS, Kamath GH, Martis J. Varicella zoster with erythema multiforme in a young girl: a rare association. Indian J Dermatol. 2014;59:299-301.
11. Breathnach SM. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis. Dalam: Burns T, Breathnach S, Cox N, Griffiths C, penyunting. Rook’s Textbook of Dermatology. Edisi ke-8. West Sussex: Wiley- Blackwell; 2010:76.1-22.
12. New Zealand Medsafe. Serious skin reactions with paracetamol. Reactions. 2014;1506:2-3.
13. United States Food and Drug Administration. FDA Drug Safety Communication: FDA warns of rare but serious skin reactions with the pain reliever/fever reducer acetami- nophen. FDA Drug Safety Communication 2013 [halaman dalam internet]. 2013. [Disitasi 25 Oktober 2019]. Diunduh dari:https://www.fda.gov/drugs/drug-safety-and- availability/fda-drug-safety-communication-fda-warns- rare-serious-skin-reactions-pain-relieverfever-reducer
14. Onishi I, Kishimoto S. Erythema multiforme after resolution of herpes zoster by acyclovir. Eur J Dermatol. 2002;12:370-2.
15. Wollina U, Gemmeke A. Herpes zoster - associated erythema multiforme. J Dermatol Case Rep. 2009;3:11-3.
16. Park IH, Kang JN, Seol JE, Sung HS, Kim H. A case of erythema multiforme followed by herpes zoster. Infection. 2014;42:799-800.
17. Hamm RL. Drug allergy: delayed cutaneous hypersensitivity reactions to drugs. EMJ Allergy Imunol. 2016;1:92-101.
18. Singh SK, Prabhu A, Kumar A. Valacyclovir- induced urticaria without acyclovir hypersensitivity. Ind J Dermatol Venereol Leprol. 2015;81:611-2.
19. Lee HJ, Kim JM, Kim GW, Mun JH, Song M, Kim HS, dkk. Fixed drug eruption due to acyclovir, valacyclovir and
famciclovir. JEADV. 2016;30:1417-9.
20. Ebo DG, Bridts CH, De Clerck LS, Stevens WJ. Immediate
allergy from valacyclovir. Allergy. 2008;63:941-2.
21. Daito J, Hanada K, Katoh N, Katoh S, Sakamoto K, Asai J, dkk. Symmetrical drug-related intertriginous and flexural exan-
thema caused by valacyclovir. Dermatology. 2009;218:60-2. 22. Zhang AJ, Warshaw EM. Allergic contact dermatitis caused by mupirocin and pimecrolimus. Contact
Dermatitis.2018;80;132-3.
23. Praz S-M, Torrente A de, Zender H, Schmied E, Schleppy
C-A, Genne D. Toxic epidermal necrolisis after topical intranasal application of mupirocin. Infect Control Hosp Epidemiol. 2003;24:459-60.
24. Blumenthal KG, Ziegler JB. Hypersensitivity reactions, dietary supplements, and the importance of the case report. J Allergy Clin Immunol Pr. 2016;4:177-8.
25. Keen MA, Hassan I. Vitamin E in dermatology. Indian Dermatol J. 2016;7:311-5.
26. Pastor-Nieto M-A, Gatica-Ortega M-E, Melgar-Molero V, Gonzalez-Munoz P, Mollejo M, Schoendorff C, dkk. Erythema multiforme-like reaction resulting from vitamin K1 oxide phytomenadione epoxide). Contact Dermatitis. 2017;77:325-6.
27. Özkaya E, Topkarci Z, Özarmaǧan G. Systemic allergic dermatitis from chromium in a multivitamin/multimineral tablet. Contact Dermatitis. 2010;62:184.
28. Oh SW, Lew W. Erythema multiforme induced by acetaminophen: a recurrence at distant sites following patch testing. Contact Dermatitis. 2005;53:56-7.
29. Ball E, Newburger A, Ackerman AB. Degos’ disease: A distinctive pattern of disease, chiefly of lupus erythematosus, and not a specific disease per se. Am J Dermatopathol. 2003;25:308-20.
30. Pirolla E, Fregni F, Miura IK, Misiara AC, Almeida F, Zanoni E. Degos disease - malignant atrophic papulosis or cutaneointestinal lethal syndrome: rarity of the disease. Clin Exp Gastroenterol. 2015;8:141-7.
31. Theodoridis A, Makrantonaki E, Zouboulis CC. Malignant atrophic papulosis (Kohlmeier-Degos disease) - a review. Orphanet J Rare Dis. 2013;8:10.
32. Kovalszki A, Weller PF. Eosinophilia. Prim Care. 2016;43:607-17.
33. Aisah S, Handoko RP. Varisela. Dalam: Menaldi SLS, Bramono K, Indriatmi W, penyunting. Ilmu Penyakit Kulit Dan Kelamin. Edisi ke-7. Jakarta: Badan Penerbit Fakultas Kedokteran Universitas Indonesia; 2018.h.128-31.
34. Bergendorff O, Hansson C. Urticaria and anaphylaxis to povi- done in a paracetamol preparation. JEADV. 2007;21:573-4.
35. Hill G, Chauvenet AR, Lovato J, McLean TW. Recent steroid therapy increases severity of varicella infections in children with acute lymphoblastic leukemia. Pediatrics. 2005;116:525-9.
1.png)
