Letter: Gianotti-Crosti syndrome and viral infection

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.

Gianotti-Crosti syndrome in an adult following recent Mycoplasma pneumoniae infection

A 44-year-old insulin-dependant diabetic woman presented with a pruritic papular eruption involving her hands, forearms and elbows. One week prior to the eruption, the patient had an upper respiratory tract infection and had taken oral ibuprofen 400 mg q.i.d. p.r.n. Skin biopsy revealed histological features consistent with Gianotti-Crosti syndrome. Serology was consistent with recent Mycoplasma pneumoniae infection and past Epstein-Barr viral infection. Her liver function tests were deranged and serum protein electrophoresis showed two sharp discrete monoclonal immunoglobulin bands. The eruption resolved completely 15 days after onset. Her serum protein studies and liver function tests subsequently normalized and she had no recurrences of her cutaneous eruption. It was concluded that the patient had Gianotti-Crosti syndrome associated with Mycoplasma pneumoniae infection.

Papular and papulovesicular acrolocated eruptions and viral infections

Twenty-six children with a symmetric papular or papulovesicular acrolocated eruption were studied to evaluate a possible link with viral infection. A history of a recent immunization was present in four patients, two of whom had a polio vaccine virus isolated from their stool samples. There was serologic evidence of a recent Epstein-Barr virus infection in one patient, adenovirus infection in another, a concurrent Epstein-Barr virus and adenovirus infection in a third, and cytomegalovirus infection in a fourth. Viral cultures were positive in two patients for adenovirus and in two others for rotavirus. Although some of the virologic findings could have been coincidental, this study confirms that multiple viral infections can be related to most papular and papulovesicular acrolocated eruptions of childhood. Virologic investigations in the earlier phases of the eruption are recommended to identify the etiologic factors of these lesions.

Gianotti-Crosti syndrome: a study of 26 cases

We have studied 26 patients presenting with a symmetrical papular or papulovesicular acrolocated eruption of more than 10 days duration. Mean age at onset was 2 years (range 10 months to 5.75 years). Lymphadenopathy was noted in eight cases, and hepatomegaly in one case. In 12 cases, histopathology and direct immunofluorescence were non-contributory. Cytolytic hepatitis occurred in one case and was associated with HBs antigenemia. A history of recent immunization was given in two cases. There was serological evidence of recent Epstein-Barr virus infection in seven out of 13 cases tested. Coxsackie B viruses were isolated from three patients, and cytomegalovirus was probably associated with the syndrome in one case. We conclude that the Gianotti-Crosti syndrome is not rare in France, and that non-hepatitis B virus (HBV)-associated cases are more frequent than the classical HBV-associated papular acrodermatitis of childhood.

Papular acrodermatitis with Epstein-Barr virus infection

A case of papular acrodermatitis (PAC) associated with Epstein-Barr virus infection occurred in a 9-month-old child. Current knowledge of the possible role of various viral antigens in PAC is discussed.

Letter: gianotti-Crosti syndrome and viral infection

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