Erythema multiforme secondary to primary varicella infection in an adult: a case report

Sofia El Haitamy, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Meryem Soughi, Department of Dermatology, Hassan II University Hospital, Faculty of Medicine, Pharmacy and Dental Medicine, Sidi Mohamed ben Abdellah University of Fez, Fez, Morocco Zakia Douhi, Department of Dermatology, University Hospital Hassan II, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Sara Elloudi, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Hanane Baybay, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Layla Tahiri-Elousrouti, Department of Pathology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco Fatima Zahrae-Mernissi, Department of Dermatology, Hassan II University Hospital, Biomedical and Translational Research Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction, most commonly triggered by herpes simplex virus. Varicella-zoster virus is a rare precipitant, with primary varicella-associated EM being exceptionally uncommon, particularly in adults. We report a 44-year-old woman who developed primary varicella, followed 5 days later by a diffuse eruption of vesicular lesions and erythematous target lesions across the trunk and extremities, with mild buccal erosions and cheilitis, suggestive of EM major. The diagnosis was confirmed by biopsy showing lymphocytic infiltration and apoptotic keratinocytes with spongy edema. This case reinforces the notion that primary varicella may be a potential trigger for EM.

Keywords: Erythema multiforme. Primary varicella. Target lesions. Varicella zoster virus.