Erythema multiforme major associated with SARS-CoV-2 infection in a patient with skin of colour

A 38-year-old man with Fitzpatrick type V skin was presented to the emergency department with a 2-week history of fever, productive cough, rhinorrhea and 5 days of oral pain. He was otherwise healthy and took no medications. He had been vaccinated against SARS-CoV-2, but SARS-CoV-2 infection was suspected and confirmed with a nasopharyngeal swab. Examination revealed erosive plaques to the oral mucosa and glans penis, as well as hemorrhagic crusting of the lips. Lesions on the upper and lower extremities had targetoid plaques with 3 concentric zones -- a central necrotic region, a palpable edematous halo and a well-circumscribed erythematous ring -- typical lesions of erythema multiforme major. However, atypical erythematous--violaceous lesions featuring 2 concentric zones with central bullae and indistinct outer borders made the clinical diagnosis unclear.