Erythema Multiforme — ORE Part 1 MCQ

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ModerateOral MedicineErythema MultiformeORE Part 1

A 50-year-old patient presents with bilateral tender submandibular lymphadenopathy, malaise, and multiple oral ulcers affecting the lips, buccal mucosa, and tongue. Target lesions are present on the dorsal surfaces of the hands. What is the most likely diagnosis?

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Correct answer: D — Erythema multiforme

The diagnosis is erythema multiforme major. The clinical presentation is pathognomonic: multiple painful oral ulcers (lips, buccal mucosa, tongue) combined with characteristic target lesions on dorsal hand surfaces. Target lesions—concentric erythematous rings with pale centre—are the hallmark of EM. This patient has EM major because oral involvement is extensive (three intraoral sites) and accompanies skin manifestations; systemic symptoms (malaise, lymphadenopathy) are typical. Stevens-Johnson syndrome (option D) is excluded because SJS involves >10% body surface area with widespread erythema and flaccid bullae; this patient has only dorsal hand lesions. Primary HSV gingivostomatitis (option B) causes vesicles confined to keratinized mucosa without systemic target lesions. Behçet disease (option C) and SLE (option E) cause oral ulcers but do not produce pathognomonic target lesions.

Reference: Erythema multiforme: a review of epidemiology, pathogenesis, clinical features, and treatment. PubMed 2014. https://pubmed.ncbi.nlm.nih.gov/24034067/