Erythema multiforme induced by tramadol: an allergy assessment

The authors report a case of erythema multiforme (EM) induced by tramadol confirmed with an allergy work-up. EM is a severe inflammatory skin disorder caused mainly by infections and rarely by drug hypersensitivity. Sulfamides, penicillins, and antiinflammatory drugs are the most common causes of drug-induced EM. An otherwise healthy 47-year-old nonatopic woman was taking acetaminophen 325 mg/tramadol 37.5 mg (Pazital) every 8 hours and etoricoxib 60 mg every 24 hours for low back pain. After 4 weeks of treatment, she experienced an eruption with symmetrical distribution of target lesions on the palms, soles, arms, and torso and then on the oral mucosa 3 days later. A biopsy specimen was taken from the right palm, and a polymerase chain reaction assay was performed to detect human herpesvirus 6, 7, and 8. The result of the serology study was negative, and infection, stress, and other possible targets of EM were not suspected. Histopathology confirmed a diagnosis of drug-induced EM. The patient was referred to the allergy department.