Case Report

A Double-Edged Puzzle: Diagnostic Challenges in Herpes-Triggered Erythema Multiforme and Methotrexate Oral Toxicity.

Volume: 29 Number: 1 March 27, 2026
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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.

Keywords

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Ethical Statement

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Thanks

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References

  1. 1. Hafsi W, Badri T. Erythema Multiforme. In: Stat Pearls. Treasure Island (FL): Stat Pearls Publishing 2024.
  2. 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. 3. Rakhi I, Prabhu N. Etiopathogenesis of erythema multiforme: a concise review. Adv Dent Oral Health 2017;5(4):555669.
  4. 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. 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. 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. 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. 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.

Details

Primary Language

English

Subjects

Oral Medicine and Pathology

Journal Section

Case Report

Authors

Smruti Mohapatra
0009-0006-7388-3379
India

Shilpiranjan Mishra
0000-0001-5618-5962
India

Atul Bajoria
0000-0001-9796-9640
India

Publication Date

March 27, 2026

Submission Date

November 11, 2025

Acceptance Date

January 27, 2026

Published in Issue

Year 2026 Volume: 29 Number: 1

DOI

https://doi.org/10.7126/cumudj.1821262

IZ

https://izlik.org/JA39JJ93KW

Cite

RIS / Bibtex
EndNote
Mohapatra S, Mishra S, Bajoria A, Sharan J (March 1, 2026) A Double-Edged Puzzle: Diagnostic Challenges in Herpes-Triggered Erythema Multiforme and Methotrexate Oral Toxicity. Cumhuriyet Dental Journal 29 1 180–183.

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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