Q176) A 48 Year old woman is evaluated in your office for a skin eruption that appeared few days ago. She has a history of Non-Hodgkin’s lymphoma that was treated 2 years ago and is in remission. A PET ( positron emission tomography) scan that was performed 3months ago did not reveal any evidence of recurrent disease. She also reports recurrent episodes of genital herpetic lesions which resolve spontaneously. Her most recent genital herpetic eruption was 4 weeks ago and it was self-limited. At this time, she is concerned about a skin eruption that is predominantly distributed on her arms, hands and feet. On examination, there is no peripheral lymphadenopathy. Genital examination is normal with out any vesicles or papules. Skin examination reveals the lesions as shown in the image below.
The most appropriate management option for this patient:
A) Observation
B) Repeat PET/CT scan
C) Start Acyclovir
D) Biopsy of the lesion
E) Start antihistamine
a?
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Ans- C , when HSV causes recurrent Erythema Multiforme, maintenance acyclovir or valacyclovir can reduce recurrences of both. (ref: FA for step3 page 26)
The rash is asymptomatic—It must be either skin eruption from meds or a sign of the disease process. This isnt herpes. I would either observe to see if it gets worse or biopsy to see what it is
Answer please
A, Just observe
target lesion
start acyclovir
erythemea multiforme
observation
acyclovir
Suppression of herpes simplex virus (HSV) can prevent HSV-associated erythema multiforme, but antiviral treatment started after the eruption of erythema multiforme has no effect on the course of the erythema multiforme. So, in this case I think the answer is A