Breaking the cycle: successful long-term remission of chronic erythema multiforme with rituximab therapy

Abstract Erythema multiforme (EM) is an immune-mediated condition marked by recurrent targetoid lesions, occasionally involving mucous membranes. Chronic or treatment-resistant cases can be difficult to manage, with limited options when standard therapies fail. We report a 37-year-old man with long-standing, refractory EM who experienced frequent flares despite trials of corticosteroids, antivirals, dapsone, methotrexate, hydroxychloroquine, ciclosporin, thalidomide and intravenous immunoglobulin. After receiving two rituximab infusions, the patient achieved complete remission, and remained symptom-free and off systemic treatment at the 5-year follow-up. This case highlights the potential role of rituximab in managing severe, treatment-resistant EM and suggests that B-cell-targeted therapy may offer long-term disease control when conventional therapies are ineffective.