Care and outcome of a child with erythema multiforme complicated by secondary bacterial infection: a case report

Erythema multiforme (EM) is an acute mucocutaneous disorder usually triggered by infections. Chemical injury with secondary bacterial infection is a rare trigger in children. We report an 11-year-old boy who initially had a punctate oral ulcer, in whom overnight buccal metronidazole likely caused additional chemical irritation, followed by secondary Staphylococcus aureus infection and a subsequent diagnosis of EM. Laboratory findings revealed a marked decrease in CD4+ T cells (185/ μ L) and a reduced CD4/CD8 ratio (0.66). Lesions progressed from the oral cavity to the extremities, with severe lip and oral involvement. Initial burn-based wound care was ineffective. Following diagnosis, a structured wound care protocol was implemented, consisting of sequential topical ethacridine lactate, mupirocin, compound triamcinolone acetonide, and recombinant human epidermal growth factor, with continuous low-flow oxygen. The lesions improved markedly, lip ulcers healed, oral function returned, and the patient was discharged well. This case underscores the need for early EM recognition in children with atypical oral lesions and describes a structured, multistep nursing strategy that was used in this case.