The Ewha Medical Journal
Ewha Womans University School of Medicine
Original Article

Clinical and Histopathological Study & Detection of Herpex Simplex Virus by the Polymerase Chain Reaction in Non-Classic Type of Erythema Multiforme

Yeon Soon Lim1, Hae Young Choi2, Ki Bum Myung2, Jeong Hee Hahm2, Woon Sup Han3

Copyright ⓒ 1999. Ewha Womans University School of Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Published Online: Mar 30, 1999

Abstract

Objectives

On previous reports about the relationship between herpes simplex virus(HSV) & erythema multiforme(EM), subjective specimens were taken from target lesions and papules of herpes-associated EM or recurrent EM of unknown etiology. PCR-positive specimen were found in target lesion of idiopathic EM and even drug induced EM. But biopsy was actually performed when the clinical finding is atypical and so diagnosis is not certain with only clinical finding. In non-classic type of erythema multiforme without herpes associated history or recurrent episode, we try to evaluate the clinical and histopathologic findings and to detect the DNA of herpes simplex virus.

Methods

We clinically and histopathologically observed the 29 cases of non-classic type of erythema multiforme through the clinical photographics, clinical charts and telephone visiting. And we also tested 29 paraffin-embedded tissues from non-classic type of erythema multiforme by PCR with two nested primer pairs.

Results

The results are as follows :

1) There are not specific difference according to age and sex.

2) The most frequent clinical type was the diffuse type(55.2%), followed by the acral type(24.1%) and central type(20.7%).

3) The major cause was idiopathic(72.4%), followed by the drug(27.6%).

4) There were various findings in clinical manifestation, including maculopatch, palulopla-que, wheal-like papule, vesicle-bullae, purpuric macule and papule and urticaria.

5) Histologically, we observed necrotic keratinocyte(48.3%) and spongiosis, exocytosis and vacuolization of basal cell in most cases. Eosinophilic infiltration, pigmentary incontinence and RBC extravasation were also seen.

6) The HSV positive specimens were fund in 2 cases(6.9%).

Conclusion

Although herpes simplex virus infection is a major contributing factor to most cases of erythema multiforme, our data supports the finding that it is not so important in non-classic type of erythema multiforme.

Keywords: Erythema multiforme; Herpes simplec virus; PCR