To report a case of bullous erythema multiforme (BEM) induced by omalizumab and discuss its management.
Approach:
Patient Description: A 36-year-old female with a history of bronchial asthma, allergic rhinitis, allergic conjunctivitis, and chronic spontaneous urticaria developed BEM after receiving omalizumab.
Clinical Presentation: The patient experienced generalized wheals, papules, plaques, vesicles, and bullae 17 days post-omalizumab injection, along with fever, chills, and fatigue.
Diagnostic Assessment: Laboratory tests revealed elevated eosinophil count and IgE levels, while skin biopsy showed necrotic keratinocytes and eosinophilic infiltration.
Treatment: Initial treatment with methylprednisolone and IVIG was ineffective; however, increasing methylprednisolone and adding oral upadacitinib controlled the condition.
Key Findings:
Omalizumab can induce bullous erythema multiforme, a rare adverse reaction.
Combination therapy with high-dose glucocorticoids and JAK inhibitors may be effective for refractory cases.
Interpretation:
Limitations:
The case study is based on a single patient, limiting generalizability.
Further research is needed to establish the frequency and mechanisms of omalizumab-induced BEM.
