Histopathologic features seen in Gianotti-Crosti syndrome secondary to Epstein-Barr virus

Gianotti-Crosti syndrome: a challenging exanthema

Gianotti-Crosti syndrome (GCS) is a self-limited condition, mainly affecting children younger than 6 years, less common in adolescents and adults. It consists of a viral exanthema with papular lesions with a flat top and symmetrical distribution, affecting predominantly extremities, gluteal region and extensor surfaces. It is often associated with viral infections but can also be related to bacterial infections, vaccination or be idiopathic. In this report, we present a case of GCS in a 13-year-old healthy female adolescent who presented with fever, odynophagia, prostration and diffuse maculopapular rash. The diagnosis of infectious mononucleosis due to infection by the Epstein-Barr virus was established. On the second week of the disease, a clinical recrudescence occurred, with worsening of the fever and modification of the exanthema characteristics. GCS is often an underdiagnosed entity. The differential diagnosis of viral exanthema can prove to be challenging and clinical suspicion is essential to achieve the diagnosis.

The Serum Immunoglobulin E Level: Is There a Relationship With the Clinical Course of the Gianotti-Crosti Syndrome?

Background: Gianotti Crosti syndrome (GCS) is a self-healing condition with a spontaneous resolution in 2-6 weeks but, even if rarely, recurrent episodes have been reported. Objective: The aim of this observational study is to investigate serum Immunoglobulin E (IgE) level in children with GCS, evaluating if there is a relationship between IgE level and clinical course of the disease. Methods: Children with GCS diagnosed at a tertiary care children's university hospital between June 2018 and November 2019 were prospectively enrolled. Demographic, clinical and hematochemical data of children investigated were collected. In particular, IgE level were investigated at symptoms onset and, if available, at the following blood tests. Patients were divided in 2 groups on the bases of the clinical course: children with a chronic relapsing course and children who did not present any relapse. Results: Among 29 patients enrolled in this study, 14 (48.3%) children had a chronic relapsing course and 15 (51.7%) did not present any relapse. A statistically significant difference was present considering the length of the disease: 210 days (IQR: 161.25-255) for patients with a chronic relapsing course compared to 40 days (IQR: 30-75) for the other group (p < 0.0001). About the median IgE level in the 2 groups, a value about 10 time higher was found in children with chronic course compared to the other group (1,144 vs. 116 U/mL) with a statistically significant difference (p < 0.0001). Conclusion: Despite the study limitations, a significant correlation between higher IgE levels and chronic-relapsing course of the GCS can be assumed.

Epstein-Barr virus: dermatologic associations and implications: part I. Mucocutaneous manifestations of Epstein-Barr virus and nonmalignant disorders

Epstein-Barr virus (EBV) is a ubiquitous virus that has been implicated in a wide range of human diseases, many of which have mucocutaneous manifestations. As a member of the herpesviridae family, EBV causes lifelong infection by establishing latency in B lymphocytes. An intact immune response is critical in preventing progression of EBV disease, and the clinical manifestations of infection are dependent on the intricate relationship between virus and host immune system. This review provides a comprehensive overview of the epidemiology, pathophysiology, and diagnostic testing in EBV infection. In part I of this continuing medical education article, the mucocutaneous manifestations of EBV infection are reviewed with an emphasis on pathophysiology and management.

Visual diagnosis: 12-month-old boy with persistent rash and lymphadenopathy

Gianotti-Crosti syndrome (GCS) is a self-limiting, papular or papulovesicular, symmetric, acral exanthem that typically presents subsequent to viral infection, bacterial infection, or immunization in a child 1 to 4 years old. The rash can persist for 2 to 10 weeks. Recent infection with Epstein-Barr virus is the most common serologic finding in patients who have developed GCS. The diagnosis is often made after the child has been unsuccessfully treated for a more common cause of an acral rash (eg, scabies). There are no pathognomonic laboratory or histopathologic findings. GCS, therefore, is still a clinical diagnosis of exclusion. The rash is self-limited, and treatment is usually not necessary. However, topical corticosteroids are anecdotally reported to reduce duration of rash. Oral antihistamines can be used to treat pruritus. Parents should be assured that resolution is almost always complete, scarring seldom occurs, and recurrence is rare.

Epstein-Barr virus and skin manifestations in childhood

Epstein-Barr virus (EBV) is a human B-lymphotropic herpes virus and one of the most common viruses in humans. Specific skin signs related to EBV infection are the exanthem of mononucleosis, which is observed more frequently after ingestion of amoxicillin, and oral hairy leukoplakia, a disease occurring mostly in immunocompromised subjects with HIV infection. Other more uncommon cutaneous disorders that have been associated with EBV infection include virus-related exanthems or diseases such as Gianotti-Crosti syndrome, erythema multiforme, and acute genital ulcers. Other skin manifestations, not correlated to virus infection, such as hydroa vacciniforme and drug-induced hypersensitivity syndrome have also been linked to EBV. The putative involvement of EBV in skin diseases is growing similarly to other areas of medicine, where the role of EBV infection is being investigated in potentially debilitating inflammatory diseases. The prognosis of EBV infection in healthy, immunocompetent individuals is excellent. However, lifelong infection, which is kept in check by the host immune system, determines an unpredictable risk of pathologic unpredictable scenarios. In this review, we describe the spectrum of non-tumoral dermatological manifestations that can follow EBV primary infection or reactivation of EBV in childhood.

Gianotti-Crosti syndrome: case report of a pruritic acral exanthema in a child

Gianotti-Crosti syndrome (GCS) is a sporadic dermatosis affecting mainly children. It is characterized by multiple, confluent, monomorphic and pruritic pink to red-brown papules or papulovesicles, distributed symmetrically on the face, extensor surfaces of the extremities and buttocks, commonly sparing the trunk, palms and soles. This can be preceded by a viral infection, and may be accompanied by fever, hepatosplenomegaly, or lymphadenopathy. Personal and family history of atopy appears to be a risk factor in the subsequent development of GCS, thus frequently diagnosed as atopic dermatitis. We report a case of a 4-year-old boy from our institution with generalized, pruritic, papulovesicular rashes on the face and extremities for one month. He was diagnosed to have atopic dermatitis and treated as such, before presentation to our institution. As the signs and symptoms in GCS are similar to atopic dermatitis, we suggest that this diagnosis be considered when presented with a similar case.

Gianotti-Crosti syndrome in a child following hepatitis B virus vaccination

Gianotti-Crosti syndrome is self-limited, characterized by papular eruption with a symmetrical distribution on the limbs and face of children, and a dermatosis of unknown etiology. However, there are many suggested factors such as a number of diseases (viral or bacterial) and vaccination. We report a case of Gianotti-Crosti syndrome that had developed 3 weeks after the hepatitis B virus vaccination.

My approach to superficial inflammatory dermatoses

Superficial inflammatory dermatoses are very common and comprise a wide, complex variety of clinical conditions. Accurate histological diagnosis, although it can sometimes be difficult to establish, is essential for clinical management. Knowledge of the microanatomy of the skin is important to recognise the variable histological patterns of inflammatory skin diseases. This article reviews the non-vesiculobullous/pustular inflammatory superficial dermatoses based on the compartmental microanatomy of the skin.

Síndrome de Gianotti-Crosti: aspectos clínicos, laboratoriais e perfis sorológicos observados em 10 casos procedentes de Belém-PA (Brasil)

FUNDAMENTOS: A síndrome de Gianotti-Crosti (SGC) é uma doença rara e autolimitada caracterizada por erupção eritematopapulosa acrolocalizada e simétrica. Relaciona-se, na maioria das vezes, com infecção pelos vírus da hepatite B e Epstein-Barr, porém há poucas publicações relacionando a SGC com herpesvírus humano tipo 6 (HHV6). OBJETIVO: Estudar aspectos clínicos e laboratoriais e investigar a participação de patógenos virais na etiologia de casos de SGC procedentes de Belém-PA. PACIENTES E MÉTODOS: Dez crianças com diagnóstico clínico de SGC foram investigadas no período de agosto de 1996 a dezembro de 2002, utilizando-se provas laboratoriais de rotina e pesquisa de anticorpos séricos específicos para determinados vírus. O diagnóstico de SGC estabeleceu-se quando, além de aspectos clínicos considerados compatíveis, um ou mais dos seguintes critérios estavam presentes: elevação das enzimas hepáticas, linfocitose, positividade sorológica para um ou mais agentes virais ou história de vacinação prévia. RESULTADOS: Seis pacientes (60%) apresentaram evidência de infecção primária pelo HHV6 demonstrada pela presença de anticorpos específicos da classe IgM. CONCLUSÃO: A detecção de anticorpos anti-HHV6 da classe IgM em seis dos pacientes apresentados sugere um possível papel etiológico desse vírus na doença, recomendando-se que seja acrescentado ao painel sorológico rotineiramente pesquisado em processos exantemáticos com morfologia sugestiva de SGC.

The diagnostic criteria of Gianotti-Crosti syndrome: are they applicable to children in India?

In order to evaluate the applicability of the diagnostic criteria to children with Gianotti-Crosti syndrome (GCS) in India we retrieved all clinical records of children with a definite diagnosis of this syndrome seen over 30 months in a private dermatology practice. The controls were children for whom Gianotti-Crosti had been suspected but the final diagnosis was not this syndrome, and children in whom it was not suspected but who were diagnosed with any of the differential diagnoses of the syndrome. We documented the presence or absence of the positive and negative clinical features for all patients and controls. The clinical records of 23 children with GCS and 74 controls were retrieved. The three positive clinical features--1) papules or papulovesicles 1-10 mm in diameter on at least three of the following four sites: cheeks, buttocks, extensor surfaces of the forearms, extensor surfaces of legs; 2) being symmetrical; 3) lasting for at least 10 days--were sensitive and positively correlated with GCS. Both negative clinical features--extensive truncal lesions and scaly lesions--are negatively correlated with this syndrome. All 23 children with GCS and none of the controls fulfilled the set of diagnostic criteria. We concluded that the Gianotti-Crosti diagnostic criteria are applicable to affected children in India.