Low-dose sertraline-induced erythema multiforme in a child.

Adverse cutaneous reactions are rare side effects of serotonin-selective reuptake inhibitors (SSRIs) (Lamoreux et al. 2006). The dermatological side effects include rashes, erythema multiforme minor, erythema multiforme major or Steven Johnson syndrome, and toxic epidermal necrolysis (Lamoreux et al. 2006; Mockenhaupt et al. 2008; Levi et al. 2009). Erythema multiforme is a dermatological condition that presents with pinkish red blotches prevalent on the extremities. The lesions are symmetrically placed and are mildly itching, though rare instances of severe itching may occur. Generally, erythema multiforme minor resolves within 7–10 days but can develop to erythema multiforme major and lifethreatening Steven Johnson’s syndrome. The classical presentation is the target lesions, which are composed of a round shape and three concentric regions; a central reddish area, an edematous pink area, and an outer lying red ring. The lesions may blister and can have only two regions, with an absent edematous pink area. The lesions may appear with varying clinical morphology, several days after the etiological event, which lends to the nomenclature—(multiforme). The dermatological presentation presents on a spectrum varying from only cutaneous involved erythema minor, to mucosal affected erythema multiforme major (or Steven-Johnson Syndrome), to severe reaction of toxic epidermal necrolysis (Lamoreux et al. 2006; Levi et al. 2009). The proposed etiology is a hypersensitivity reaction, and causative factors include mycoplasma pneumoniae, herpes simplex virus infections, autoimmune diseases, and medications (Lamoreux et al. 2006; Mockenhaupt et al. 2008; Levi et al. 2009). SSRIs have rarely been implicated with sertraline, the only drug cited for Steven Johnson syndrome and toxic epidermal necrolysis (Bodokh et al. 1992; Mockenhaupt et al. 2008; Lange-Asschenfeldt et al. 2009; Levi et al. 2009). Sertraline has been reported in six cases, all of whom were adults (Gales and Gales 1994; Beauquier and Fahs 1998; Jan et al. 1999; Thédenat et al. 2001; Lange-Asschenfeldt et al. 2009). We present sertraline-induced erythema multiforme in a 9-year-old boy, which to our knowledge is the only case described in a child.