Herpes-Associated Erythema Multiforme
A 32-year-old man presented to the emergency department with itchy lesions on both palms that appeared over the preceding 3 days. He reported no associated fevers or recent medication use but had had a similar episode 6 months earlier in which the lesions had resolved without treatment over a period of 2 weeks. He also noted a history of recurrent oral herpes simplex infection, including an episode that had started several days before the appearance of the lesions on his palms. Physical examination revealed targetoid erythematous lesions with erosive centers that were limited to the palm. There was no mucosal involvement, but subtle erosions were observed on the vermillion border of the inferior lip, findings consistent with resolving herpetic lesions. The lesions on the palms were consistent with erythema multiforme, a condition that may develop in response to certain infections (most commonly herpes simplex virus) but that may also be associated with certain medications or autoimmune conditions. At a follow-up visit 7 days after presentation, the lesions had resolved without specific treatment.