# Erythema Multiforme in an HIV+ Patient on Highly Active Antiretroviral Therapy After Starting Paxlovid (Nirmatrelvir-Ritonivir)

## TL;DR

An HIV+ patient developed erythema multiforme after taking Paxlovid for COVID-19, with symptoms improving only slightly.

## Contribution

This case highlights a possible link between Paxlovid and erythema multiforme in HIV+ patients.

## Key findings

- The patient developed oral and cutaneous lesions resembling erythema multiforme after Paxlovid treatment.
- Intravenous steroids and antihistamines provided only mild improvement.
- Biopsy and infectious workup did not reveal an alternative cause.

## Abstract

In this report, we present a case of a woman currently on HIV antiretroviral therapy who presented with oral mucosal and cutaneous skin lesions with a target-like appearance following completion of a five-day course of Paxlovid™ for symptomatic COVID-19 infection. The patient was treated with intravenous steroids and oral antihistamines with mild improvement. However, she returned in one week with worsening skin lesions. The biopsy and infectious workup were non-contributory. It was determined that the patient had developed erythema multiforme (EM), secondary to Paxlovid™.