Treatment of recurrent erythema multiforme with adalimumab as monotherapy

DIEM: drug-induced erythema multiforme EM: erythema multiforme HAEM: herpes-associated erythema multiforme HSV: herpes simplex virus PCR: polymerase chain reaction INTRODUCTION Adalimumab is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor. We report a case of recurrent erythema multiforme (EM) recalcitrant to previous therapy that showed complete response to adalimumab. SJS: Stevens-Johnson syndrome TEN: toxic epidermal necrolysis TNF: tumor necrosis factor CASE REPORT An African-American man in his late teens with glucose-6-phosphate dehydrogenase deficiency presented with a 2-year history of recurrent EM. Lesions waxed and waned in timing and intensity with recurrent palm, sole, and oral mucosal lesions most characteristic. The patient was experiencing separate episodes every 6 to 8 weeks of variable duration and would heal between flares. At his baseline dermatologic examination, the patient had multiple violaceous targetoid macules over his bilateral palms, soles, and volar forearms. Additionally, the patient had erosion and hemorrhagic crusting of the lips with additional presence of scattered buccal mucosal erosions (Fig 1). Biopsy findings of a targetoid macule were histologically consistent with EM. The patient had a documented history of a tender vesicular eruption of the upper labial mucosa consistent with herpes labialis treated with valacyclovir. He additionally tested positive for herpes simplex virus (HSV)-1 by plasma polymerase chain reaction (PCR) but did not have viral culture or lesional PCR completed. Further workup was negative for mycoplasma by both PCR and blood titers. Other potential etiologies of recurrent oral erosions and cutaneous lesions were considered in the workup of this patient, but he was otherwise healthy, not on any medications or supplements, and followed up with