Papular-purpuric "gloves and socks" syndrome in a mother and daughter

A Rare Case of Papular-Purpuric "Gloves and Socks" Syndrome Associated with Influenza

Papular‐purpuric “gloves and socks” syndrome (PPGSS) is a unique, self‐limited dermatosis characterized by edema, erythema, and pruritic petechiae and papules in a distinct “gloves and socks” distribution. This is often accompanied by systemic symptoms, including fever, lymphadenopathy, asthenia, myalgia, and arthralgias. PPGSS has also been described as a manifestation of an underlying immunological mechanism that can be triggered by viral or drug‐related antigens. A 32‐year‐old male developed a painful eruption on the bilateral hands and feet after being diagnosed with influenza B. On examination, scattered papular purpura with occasional overlying scale was noted on the bilateral hands, fingers, feet, toes, volar wrists, and ankles. Histopathologic sections showed a mixed pattern of inflammation with interface and spongiotic changes. A parakeratotic scale with overlying basket‐weave orthokeratosis was also seen. Within the epidermis, there was intraepidermal vesicles and Langerhans cell microabscess formation with scattered apoptotic keratinocytes. The underlying dermis showed a superficial perivascular lymphocytic infiltrate with mild edematous changes, and extravasation of red blood cells. Clinicopathologic correlation strongly supported a diagnosis of popular‐purpuric gloves and socks syndrome. The influenza virus has never been reported in association with PPGSS; thus, this case outlines an important new variant that clinicians should be familiar with.

Human Parvoviruses

Parvovirus B19 (B19V) and human bocavirus 1 (HBoV1), members of the large Parvoviridae family, are human pathogens responsible for a variety of diseases. For B19V in particular, host features determine disease manifestations. These viruses are prevalent worldwide and are culturable in vitro, and serological and molecular assays are available but require careful interpretation of results. Additional human parvoviruses, including HBoV2 to -4, human parvovirus 4 (PARV4), and human bufavirus (BuV) are also reviewed. The full spectrum of parvovirus disease in humans has yet to be established. Candidate recombinant B19V vaccines have been developed but may not be commercially feasible. We review relevant features of the molecular and cellular biology of these viruses, and the human immune response that they elicit, which have allowed a deep understanding of pathophysiology.

Clothing-related Eponyms and Signs

The world of dermatology is pieced together by clinical conditions unique in their colors, morphology, and configuration. Dermatological signs and terms are influenced by etymology, language, and history. Eponyms also make dermatology a fascinating but linguistically challenging subject. This article reviews dermatological conditions described in relation to fashion, and what we wear in everyday life from top to toe, demonstrating that dermatology can be inspired even in the most common things.

Pityriasis Rosea, Gianotti-Crosti Syndrome, Asymmetric Periflexural Exanthem, Papular-Purpuric Gloves and Socks Syndrome, Eruptive Pseudoangiomatosis, and Eruptive Hypomelanosis: Do Their Epidemiological Data Substantiate Infectious Etiologies?

Many clinical and laboratory-based studies have been reported for skin rashes which may be due to viral infections, namely pityriasis rosea (PR), Gianotti-Crosti syndrome (GCS), asymmetric periflexural exanthem/unilateral laterothoracic exanthem (APE/ULE), papular-purpuric gloves and socks syndrome (PPGSS), and eruptive pseudo-angiomatosis (EP). Eruptive hypomelanosis (EH) is a newly discovered paraviral rash. Novel tools are now available to investigate the epidemiology of these rashes. To retrieve epidemiological data of these exanthema and analyze whether such substantiates or refutes infectious etiologies. We searched for articles published over the last 60 years and indexed by PubMed database. We then analyzed them for universality, demography, concurrent patients, temporal and spatial-temporal clustering, mini-epidemics, epidemics, and other clinical and geographical associations. Based on our criteria, we selected 55, 60, 29, 36, 20, and 4 articles for PR, GCS, APE/ULE, PPGSS, EP, and EH respectively. Universality or multiple-continental reports are found for all exanthema except EH. The ages of patients are compatible with infectious causes for PR, GCS, APE/ULE, and EH. Concurrent patients are reported for all. Significant patient clustering is demonstrated for PR and GCS. Mini-epidemics and epidemics have been reported for GCS, EP, and EH. The current epidemiological data supports, to a moderate extent, that PR, GCS, and APE could be caused by infectious agents. Support for PPGSS is marginal. Epidemiological evidences for infectious origins for EP and EH are inadequate. There might be growing epidemiological evidence to substantiate or to refute our findings in the future.

Mycoplasma pneumoniae infection presenting as bullous papular purpuric gloves and socks syndrome: novel association and review of the literature

Papular purpuric gloves and socks syndrome (PPGSS) is a self-limited, often febrile illness with symmetric edema and erythema of the hands and feet; papular, petechial, and purpuric acral dermatosis; and mucosal lesions in children and young adults. Most of the cases of PPGSS have been reported to be caused by parvovirus B19 and other viruses. This study describes a case resulting from Mycoplasma pneumoniae infection in an adolescent male and reviews the literature.

Papular-purpuric gloves and socks syndrome in children and adolescents

We describe the case of a 12-year-old boy with gloves and socks syndrome caused by coinfection with HHV-6 and PVB19, and review the published cases from 5 to 18 years of age to profile the disease in this age group. The review of the literature yielded 25 cases of gloves and socks syndrome. Most patients were febrile and had acute PVB19 infection.

[A 28-year-old patient with exanthema on hands and feet]

We report on a case of papular-purpuric gloves and socks syndrome (PPGSS). Our 28-year-old female patient showed a typical exanthema on hands and feet followed by high fever, cervical swelling of lymph nodes and general symptoms. Clinical and paraclinical tests led to a diagnosis of PPGSS. This is, in most cases, caused by viral infections, in particular by the parvovirus B19. After recovering, the daughter of our patient suffered from erythema infectiosum, a typical infection caused by parvovirus B19.

[Papular-purpuric gloves and socks syndrome--a case report]

INTRODUCTION

Papular-purpuric gloves and socks syndrome is a rare manifestation associated with acute seronegative arthritis and skin lesions. It is triggered by a viral infection, most commonly by Human parvovirus B19 or Coxsackie group of viruses, but precise viral diagnosis is not obtained in all cases.

CASE REPORT

A 54-year old male patient experienced sudden, intense pain and swelling in the carpal area of his left hand. He also presented with unusual skin lesions, and grouped small purpuric-papules on the dorsal side of the left hand. During the next few days, both feet were similarly affected. In the next four weeks, a transient liver damage occurred, with a moderate increase in liver enzymes. Apart from elevated erythrocyte sedimentation rate and fibrinogen levels, other findings were within normal limits (complete blood and reticulocyte count, parameters of rheumatic and autoimmune diseases, abdominal ultrasound scan, radiographs of the chest and of affected hand and feet joints, urethral smears for isolation of trichomonas, yeasts and chlamydia trachomatis, and Syphilis, Borrelia, Toxoplasmosis, and Mycoplasma pneumoniae serology). Apart from positive tests for HPvB19, other viral serology tests were all negative (Coxsackievirus, Adenovirus, Influenza, Hepatitis B and C virus, HIV). The skin lesions resolved in about three weeks, the intensity of joint pain decreased, but lasted for the next 6 months.

CONCLUSION

The diagnosis of papular-purpuric gloves and socks syndrome was made on the basis of the characteristic clinical picture, and confirmed by virus serology.

Parvovirus B19 infection in children with acute illness and rash

Parvovirus B19 is responsible for a variety of cutaneous diseases, including erythema infectiosum and papular purpuric gloves-and-socks syndrome. It is also associated with other dermatologic diseases, such as systemic lupus erythematosus. To study the prevalence of parvovirus B19 infection in children with acute illness and rash, we did a prospective study of 110 children at the Chiang Mai University teaching hospital from January 2001 to November 2003. Sera from these patients were analyzed for immunoglobulin M and immunoglobulin G antibodies against human parvovirus B19 using enzyme-linked immunosorbent assay techniques. From a total of 110 patients with acute illness and rash, there were paired serum samples for 90 patients and single serum sample for 20 patients. For those with paired serum samples, there were three patients with recent parvovirus B19 infection that presented with erythema infectiosum, urticaria, and lupus erythematosus, respectively. Immunoglobulin G antibodies were tested in serum samples of 103 children; 28.2% were positive. These data indicate that parvovirus B19 is not a common cause of acute illness and rash in children.

Generalized petechial eruption induced by parvovirus B19 infection

Parvovirus infection classically causes erythema infectiosum. During the past 2 decades, other unusual skin eruptions have been noted in association with parvovirus infection. Papular purpuric gloves and socks syndrome is one form of parvovirus infection described mostly in white, young adult patients. Recently, there have been reports of a few patients with acropetechial syndrome consisting of a papular purpuric gloves and socks syndrome-like presentation with additional involvement of the perioral and chin area, temporally associated with acute parvovirus B19 infection. We report a case of a 7-year-old boy with serologic evidence of acute parvovirus B19 infection who developed a generalized petechial eruption with lesions concentrated on his extremities and face. We also reviewed the literature and summarized the various cutaneous presentations of parvovirus infection.