Erythema multiforme secondary to primary varicella infection in an adult: a case report

Erythema multiforme (EM) is an acute mucocutaneous hypersensitivity reaction, most commonly triggered by herpes simplex virus. Varicella-zoster virus is a rare precipitant, with primary varicella-associated EM being exceptionally uncommon, particularly in adults. We report a 44-year-old woman who developed primary varicella, followed 5 days later by a diffuse eruption of vesicular lesions and erythematous target lesions across the trunk and extremities, with mild buccal erosions and cheilitis, suggestive of EM major. The diagnosis was confirmed by biopsy showing lymphocytic infiltration and apoptotic keratinocytes with spongy edema. This case reinforces the notion that primary varicella may be a potential trigger for EM.