Typical target lesion with a central blister in erythema multiforme major caused by drug allergy in a toddler

Erythema multiforme (EM) is an uncommon acute mucocutaneous illness with target lesions primarily on the face and limbs. Slow-onset hypersensitivity reactions to infections (including herpes simplex virus mycoplasma pneumonia) medicines antibiotics, anticonvulsants, nonsteroidal anti-inflammatory drugs) cause EM. A 4-year-old male EM after taking metamizole, ampicillin, cloxacillin, unknown puffer, major developed lip sores blisters various places of his body. Dermatological examination revealed haemorrhagic crusts lips. On both hands feet, typical central blisters, purplish red in color, well-defined boundaries, round oval form, variable size were seen. There erythematous macules genital oedema. blood test higher levels leucocytes CRP. Serological testing no IgG, IgM, or anti-HSV1&2 antibodies. The X-ray chest was normal. Clinical improvement occurred elimination suspected drugs intravenous dexamethasone, gentamicin, paracetamol, oral cetirizine, fusidic acid 2% cream, 0.9% NaCl compress, sterile gauze. diagnosis established based presence multiple symmetrical distribution extremities (dorsal surfaces feet), involvement mucosal drugs. Negative IgG IgM Anti HSV 1&2 results lead drug allergy-related Multiforme Major.