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Lima I ; Daniela M. Rocha II ; Mario F. Gianotti-Crosti syndrome GCS is a rare, self-limited disease characterized by a symmetrical erythematopapulous, acral-based eruption. In most cases a definite relationship with a viral infection can be established, especially when hepatitis B or Epstein-Barr viruses are involved.

To study clinical and laboratorial aspects as well as to investigate the role of viral pathogens in the etiology of GCS cases from Belem PABrazil. From August to Decemberten children with a clinical diagnosis of GCS were investigated through routine laboratory exams and serologically screened for several virus specific antibodies.

A diagnosis of GCS was considered for cases that presented clinical aspects considered suggestive, together with one or more of the following criteria: Consequently, the authors recommend that this virus is added to the routine serological tests when exanthematous processes are concerned, especially those with a morphology suggestive of GCS. Gianotti-Crosti syndrome GCS was described for the first time in by Gianotti as a papular, monomorphic eruption, self-limited, and symmetrically distributed in the face, in the gluteal area and in the extremities.

It occurs in children from two to six years of age. During the etiological investigation of the cases presented here, it was verified that these eruptions may be caused by various infectious agents, mainly viral Table 1.

The course of GCS is benign and self-limited, the manifestations disappearing within two to eight weeks, with no recurrence. Lymphocytosis, with occasional presence of atypical lymphocytes in the peripheral blood, may also be observed.

From August to Decembera study was made of ten children in the city of Belem, with ages ranging between one month and ten years mean: Seven were boys and three, girls. The following laboratory exams were performed in each case: Any exceptions to these procedures are described in Table 3. In six cases, biopsies of cutaneous lesions were collected and stained with hematoxylin and eosin H-E. Histopathological aspects were not considered as diagnostic criteria, serving rather to exclude the possibility of other diseases.

The diagnosis of GCS was established by a correlation between clinical and laboratorial factors. In addition to the clinical aspects considered compatible with this diagnosis, one or more of the following criteria were present: In the case attributed to HCV, it was considered to be a vertical transmission from mother to fetus, confirmed serologically, as a valid isolated criterion.


Due to a lack of resources, molecular tests were not accomplished.

All the patients presented symmetrical cutaneous monomorphic eruptions, consisting of erythematous papules, brownish and at times lichenoid, with a diameter varying from 1 to 5 mm. These were predominantly located in the face Figure 1 and limbs Figures 2 and 3. The trunk was involved in nine cases, but generally with less intensity. Five patients complained of pruritus. Fever was observed in seven cases, lymphadenopathy in four and respiratory catarrhal manifestations in one.

In all of the cases, spontaneous remission of the condition occurred within one week to six months Table 2. During the course of the disease only systemic symptomatic medications were prescribed; including antihistaminic and antipyretic agents, when necessary.

Lymphocytosis, occasionally with atypical lymphocytes, was observed in five cases. Transaminases presented a discreet elevation in four patients. An increase of bilirubin occurred only in the case related to hepatitis C.

In two patients, high levels of alkaline phosphatase were also found.

Microcytic and hypochromic anemia was observed in seven patients. Table 3 shows the results of the serological viral tests. Patient number 5, whose possible etiology was attributed to the triple Acrodermagitis vaccine, was only submitted to serologic testing for viral hepatitis. A wide spectrum of infectious agents has been suspected to cause GCS Table 1with EBV figuring as the most frequent pathogen, followed by hepatitis B virus.

This was done using the plasma and leukocytes from the peripheral blood of 10 patients diagnosed with GCS. Those authors observed that two patients both children presented evidence of an active infection by HHV6 and concluded that a primary HHV6 infection can be associated ka this syndrome in children. The current spectrum of infectious agents associated with GCS may be influenced by epidemiological acrofermatitis linked to the distribution of the viruses.

Its form may be subclinical or inancia may cause exanthemas and lymphoproliferative disturbances. In another publication, those same authors, having accompanied, between January and Decembera infanciia of children under seven years of age registered at eight community day care centers in Belem, observed that infection by HHV6 had occurred in five out of every eight children during the studied period.

They concluded that HHV6 infection is frequent among children in the area of Belem. Case 1, a one-month-old infant, was born of a mother who was a carrier of HCV and presented positive serology for anti-HCV. The diagnosis of GCS in the infant, verified in a clinical-laboratorial correlation, suggested a probable vertical transmission of the infection.

Gianotti–Crosti syndrome – Wikipedia

In this regard, three reports in the consulted literature relate hepatitis C virus with GCS. The vaccine had been applied three months prior to the appearance of the symptoms. Such an association with vaccines shows strong corroboration in acroder,atitis published works, reporting that the cutaneous eruption occurs on average two to six weeks after the vaccination.

They observed that the acrodermatiti associated with HBV were clinically indistinguishable from those produced by any other agent. They suggested that clinical variations depended on the patients’ individual characteristics rather than on different pathogens.


In this way it is not possible a priori to attribute an etiological agent for each case, which in fact occurred in this series, in that six patients, with HHV6 as the cause, presented a certain diversity in the clinical-laboratorial manifestations. The differential diagnosis should be made with the following: They suggest that pediatricians and dermatologists are possibly under-diagnosing the disease, since it can be easily confused with other papulovesicular illnesses of childhood.

The histopathological alterations are nonspecific and include focal parakeratosis, spongiosis, edema of the papillary dermis with leakage of erythrocytes and a superficial perivascular inflammatory lymphohistiocytic infiltrate; eventually a dermatitis of the superficial interface may be observed. The histopathological findings for three of these were in agreement with the available data in the consulted literature. The association of this virus predominated in the research series presented here.

The fact that this pathogen is highly prevalent in children, as shown by the results in the present work, indicates that it should be added to the panel of routine serologic tests in cases with a clinical picture suggestive of GCS. Rilievi di una particolare casistica tossinfettiva caratterizzata da un ‘eruzione eritemato-infiltrativa desquamativa a focolai lenticolari, a sede elettiva acroposta. L’acrodermatite papulosa infantile “malattia”. An epidemic of infantile papular acrodermatitis Gianotti-Crosti syndrome due to Epstein-Barr virus.

Blauvelt A, Turner ML. Gianotti-Crosti Syndrome and human immunodeficiency virus infection. A prospective case control study of the association of Gianotti-Crosti syndrome with human herpesvirus 6 and human herpesvirus 7 infections. Gianotti-Crosti syndrome as a presenting sign of EBV-induced acute infectious mononucleosis.

Bol Med Hosp Infant Mex. Gianotti-Crosti syndrome associated with Epstein-Barr virus infection. Mooney E, Kempf W. Dermatologic disorders associated with viral hepatitis infections. Smith KJ, Skelton H. Histopathologic features seen in Gianotti-Crosti syndrome secondary to Epstein-Barr virus.

J Am Acad Dermatol.

Gianotti-Crosti Syndrome presenting as lichenoid dermatitis. Human immunodeficiency virus and the Gianotti-Crosti syndrome.

Gianotti-Crosti syndrome after measles, mumps and rubella vaccination. Gianotti-Crosti syndrome associated with infections other than hepatitis B.

Gianotti–Crosti syndrome

Isolation of a new virus, HBLV, in patients with lymphoproliferative disordes. Rev Inst Med trop S Paulo. Trans roy Soc trop Med Hyg. Diagnostic criteria for Gianotti-Crosti syndrome: Human herpesviruses 6 and 7: Received on January 19, Approved by the Consultive Council and accepted for publication on October 30, All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. RESULTS All the patients presented symmetrical cutaneous monomorphic eruptions, consisting of erythematous papules, brownish and at times lichenoid, with a diameter varying from 1 to 5 mm.

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