Journal of Clinical Neonatology

: 2015  |  Volume : 4  |  Issue : 4  |  Page : 288--289

Erythema multiforme: A rare presentation of neonatal fungal urinary tract infection

Shilpa Kalane, Pradeep Suryawanshi, Umesh Vaidya 
 Department of Neonatology, Sahyadri Speciality Hospital, Pune, Maharashtra, India

Correspondence Address:
Shilpa Kalane
Flat No. 202, G. Building, Wondercity, Katraz-S.N.76, Pune-46, Maharashtra


Erythema multiforme (EM) is an acute, self-limiting, mucocutaneous hypersensitivity reaction characterized by distinctive target lesions. Most cases have been attributed to infection. EM occurs mainly in young adults and is extremely rare during the neonatal period. We report an 11-day-old boy who presented with target skin lesions on upper limbs and lower limbs with no other associated symptoms. He had no remarkable maternal, birth, or past medical history. Complete blood count, chest radiography, and herpes simplex virus 1 and 2 immunoglobulin G titers revealed no abnormalities. Urine analysis showed fungal hyphae and culture grew candida albicans. Lesions disappeared after starting antifungal. Pathologic examination showed vacuolar interface change and dyskeratotic cells in the epidermis consistent with EM. This unusual case emphasizes the importance of recognizing diagnostic clues in examining patients.

How to cite this article:
Kalane S, Suryawanshi P, Vaidya U. Erythema multiforme: A rare presentation of neonatal fungal urinary tract infection.J Clin Neonatol 2015;4:288-289

How to cite this URL:
Kalane S, Suryawanshi P, Vaidya U. Erythema multiforme: A rare presentation of neonatal fungal urinary tract infection. J Clin Neonatol [serial online] 2015 [cited 2020 Feb 24 ];4:288-289
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Full Text


Erythema multiforme (EM) is an acute, self-limited disorder involving the skin and mucous membranes with common recurrences. EM affects males more often than females, with a male:female ratio ranging from 3:2 to 2:1. Although it can occur in all ages, EM rarely occurs during infancy and childhood. Indeed, there have been only four cases of biopsy-proven EM during the neonatal period in the literature. Here, we report a case of EM in a neonate due to fungal urinary tract infection (UTI).

 Case Report

An 8-day-old male late preterm infant was admitted to our hospital on day 1 of life for respiratory distress from congenital pneumonia, was put on continuous positive airway pressure. Distress settled over next 2 days. On day 11 of life, baby developed skin lesions on lower limbs then spread to his entire body within a day. His entire body was covered with well-defined annular erythematous patches of variable size, which were typical targetoid shape. The center of the round erythematous patches was darker than the periphery [Figure 1]. However, the face, palms, soles and mucous membranes were spared. The rest of his physical examination was normal [Figure 1]a and [Figure 1]b.{Figure 1}

Septic screen was sent. Laboratory evaluation showed normal hemogram. Urine routine showed fungal hyphae and culture grew candida albicans. Serologic findings, including antibodies to herpes simplex virus (HSV) was negative. A skin biopsy specimen obtained from his right lower leg revealed a lymphohistiocytic infiltration in the upper dermis with papillary edema. Vacuolar degeneration of the basal cell layer and necrotic keratinocytes within the epidermis were also observed. These findings were compatible with the diagnosis of erythema multiforme (EM).

The patient improved rapidly upon administration of intravenous Fluconazole. The skin lesions cleared without scarring within a few days; urine culture was sterile. At 3 months of follow-up, there had been no recurrence or other systemic sequelae.

Erythema multiforme occurs commonly in adolescents and young adults. Many factors have been linked to the development of EM. Infections (viral, bacterial, or fungal) account for approximately 90% of cases, with HSV as the most commonly identified precipitant. However, it has rarely been reported in neonates and infants.[1] Moreover, to our knowledge, there [2],[3] have been only three cases of biopsy-proven EM during the neonatal period, and no such cases have been reported in India.

In this case, the patient did not show any systemic symptoms except for a rash. Considering that EM is a reactive phenomenon. Fungal urinary tract infection could have been related to the development of the skin lesions. Dermatological complications after fungal infection are commonly seen; however, they include specific skin reactions such as tinea capitis, diaper dermatitis, etc., Until date, there have not been reports suggesting EM due to fungal infection in neonates. These reactions may be mediated by immunological hypersensitivity reaction to antigens in the vaccine. However, the exact pathogenesis remains unclear.

Further studies are needed to evaluate the etiologies and treatment of neonatal EM, and dermatologists should pay attention to this rare event.

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Conflict of Interest:

None declared.


1Weston WL, Morelli JG. Herpes simplex virus-associated erythema multiforme in prepubertal children. Arch Pediatr Adolesc Med 1997;151:1014-6.
2Dikland WJ, Oranje AP, Stolz E, van Joost T. Erythema multiforme in childhood and early infancy. Pediatr Dermatol 1986;3:135-9.
3Johnston GA, Ghura HS, Carter E, Graham-Brown RA. Neonatal erythema multiforme major. Clin Exp Dermatol 2002;27:661-4.