A Double-Edged Puzzle: Diagnostic Challenges in Herpes-Triggered Erythema Multiforme and Methotrexate Oral Toxicity.
Abstract
A 56-year-old female on long-term methotrexate presented with painful oral ulcerations diagnosed as erythema multiforme. Despite continued methotrexate use, lesions resolved with acyclovir and corticosteroids, confirming herpes simplex virus-associated erythema multiforme. This case highlights the importance of therapeutic response in distinguishing viral triggers from drug-induced causes for accurate management.
Ethical Statement
NA
Supporting Institution
NA
Project Number
NA
Thanks
NA
References
- 1. Hafsi W, Badri T. Erythema Multiforme. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing 2024.
- 2. Dharel S, Koirala B, Dali M. Oral erythema multiforme attributed to herpes simplex virus: a less recognized variant. Clin Case Rep 2024;12(9):e9388.
- 3. Rakhi I, Prabhu N. Etiopathogenesis of erythema multiforme: a concise review. Adv Dent Oral Health 2017;5(4):555669.
- 4. Tirú-Vega MA, Engel-Rodriguez N, Rivera-Bobé N, Cruz-Díaz CN. A rare skin rash: Linezolid-induced purpuric drug eruption without vasculitis in a Puerto Rican man. Am J Case Rep 2023,24, e941725.
- 5. Prathap TA, Lokeshvara D, Abinish DG, Kalaivani S, Aswin J. A rare case report on linezolid induced fixed drug eruption. Int J Res Dermatol 2025;11(2),167-170.
- 6. Spellberg B, Nielsen TB, Phillips MC, Ghanem B, Boyles T, Jegorović B, et al. Revisiting diagnostics: erythrocyte sedimentation rate and C-reactive protein: it is time to stop the zombie tests. Clin Microbiol Infect 2025;31(1);1-4.
- 7. Cruz AC, Fidelis YP, Vieira LS, Figueiredo PT, Duarte DB, Lia EN et al. Methotrexate induced erythema multiforme: a case report of accidental overdose. Rev Bras Farm Hosp Serv Saude 2021;12(3):0642.
- 8. Carvalho CG, Terrabuio BR, Moura LL, Manzano BR, Simpione G, Caminha RDG, et al. Oral manifestations of erythema multiforme due to methotrexate intoxication. Int J Odontostomatol 2022;16(2):195-201.
- 9. Muryah AE, Sufiawati I. Successful treatment of herpes simplex–associated erythema multiforme with a combination of acyclovir and prednisone. J Dentomaxillofac Sci 2017;2(3):191-193.
Çift Taraflı Bir Bulmaca: Herpes Tetiklemeli Eritema Multiforme ve Metotreksat Oral Toksisitesinde Tanısal Zorluklar.
Abstract
Uzun süredir metotreksat kullanan 56 yaşında bir kadın, eritema multiforme tanısı konulan ağrılı ağız ülserleriyle başvurdu. Metotreksat kullanımına devam edilmesine rağmen, lezyonlar asiklovir ve kortikosteroidlerle iyileşerek herpes simpleks virüsüyle ilişkili eritema multiforme'u doğruladı. Bu vaka, doğru tedavi için viral tetikleyicileri ilaca bağlı nedenlerden ayırmada tedavi yanıtının önemini vurgulamaktadır.
Ethical Statement
Uygulanamaz
Supporting Institution
Uygulanamaz
Project Number
NA
Thanks
Uygulanamaz
References
- 1. Hafsi W, Badri T. Erythema Multiforme. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing 2024.
- 2. Dharel S, Koirala B, Dali M. Oral erythema multiforme attributed to herpes simplex virus: a less recognized variant. Clin Case Rep 2024;12(9):e9388.
- 3. Rakhi I, Prabhu N. Etiopathogenesis of erythema multiforme: a concise review. Adv Dent Oral Health 2017;5(4):555669.
- 4. Tirú-Vega MA, Engel-Rodriguez N, Rivera-Bobé N, Cruz-Díaz CN. A rare skin rash: Linezolid-induced purpuric drug eruption without vasculitis in a Puerto Rican man. Am J Case Rep 2023,24, e941725.
- 5. Prathap TA, Lokeshvara D, Abinish DG, Kalaivani S, Aswin J. A rare case report on linezolid induced fixed drug eruption. Int J Res Dermatol 2025;11(2),167-170.
- 6. Spellberg B, Nielsen TB, Phillips MC, Ghanem B, Boyles T, Jegorović B, et al. Revisiting diagnostics: erythrocyte sedimentation rate and C-reactive protein: it is time to stop the zombie tests. Clin Microbiol Infect 2025;31(1);1-4.
- 7. Cruz AC, Fidelis YP, Vieira LS, Figueiredo PT, Duarte DB, Lia EN et al. Methotrexate induced erythema multiforme: a case report of accidental overdose. Rev Bras Farm Hosp Serv Saude 2021;12(3):0642.
- 8. Carvalho CG, Terrabuio BR, Moura LL, Manzano BR, Simpione G, Caminha RDG, et al. Oral manifestations of erythema multiforme due to methotrexate intoxication. Int J Odontostomatol 2022;16(2):195-201.
- 9. Muryah AE, Sufiawati I. Successful treatment of herpes simplex–associated erythema multiforme with a combination of acyclovir and prednisone. J Dentomaxillofac Sci 2017;2(3):191-193.
Details
| Primary Language | English |
|---|---|
| Subjects | Oral Medicine and Pathology |
| Journal Section | Case Report |
| Authors | |
| Project Number | NA |
| Submission Date | November 11, 2025 |
| Acceptance Date | January 27, 2026 |
| Publication Date | March 27, 2026 |
| DOI | https://doi.org/10.7126/cumudj.1821262 |
| IZ | https://izlik.org/JA39JJ93KW |
| Published in Issue | Year 2026 Volume: 29 Issue: 1 |
Cumhuriyet Dental Journal (Cumhuriyet Dent J, CDJ) is the official publication of Cumhuriyet University Faculty of Dentistry. CDJ is an international journal dedicated to the latest advancement of dentistry. The aim of this journal is to provide a platform for scientists and academicians all over the world to promote, share, and discuss various new issues and developments in different areas of dentistry. First issue of the Journal of Cumhuriyet University Faculty of Dentistry was published in 1998. In 2010, journal's name was changed as Cumhuriyet Dental Journal. Journal’s publication language is English.
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