LAUSR

A 51-year-old male construction worker with type 2 diabetes mellitus, hypertension, and dyslipidaemia, treated for several years with metformin, olmesartan/amlodipine, and atorvastatin, was admitted to the department of dermatology because of the sudden appearance of facial oedema accompanied by erythema and tense bullae with onset in the head, neck, and upper limbs, evolving during 3 days. Later, the intense pruritic dermatosis progressed to the trunk and, to a lesser extent, the lower limbs. Dermatological examination showed target lesions, some with tense bullae arranged on the margins, on the upper limbs, trunk, and lower limbs (Figures 1–3). Cutaneous detachment and erosions were present on <20% of the body surface area, particularly on the back, and the Nikolsky sign was positive. There were also erosions of the oral mucosa and oedema of the glans penis. This clinical picture suggested a case of erythema multiforme major. Laboratory examinations, namely infectious serological investigations for herpes simplex virus, Epstein-Barr virus, cytomegalovirus, and Mycoplasma pneumoniae, gave unremarkable findings. A skin biopsy taken from a target lesion of the left arm showed the formation of subepidermal blisters containing lymphocytes mixed with eosinophils and necrotic keratinocytes, which are aspects compatible with the clinical diagnosis of bullous erythema multiforme. The patient was treated with prednisolone and intravenous immunoglobulins, with progressive clinical improvement. Skin and mucosal lesions completely resolved within 2 weeks. The patient denied previous viral infection, particularly with herpes virus, or the introduction of new drugs. However, after detailed questioning, he revealed that, in the week previous to the onset of the dermatosis, he had handled a different exotic wood (pao santo/ ferro; M. scleroxylon Tul.) at his workplace. One month after the dermatitis had healed, patch tests with the Portuguese Contact Dermatitis Group baseline series and sawdust of