January 2007

A 4-year-old boy with a two-day history of an eruption presents with juicy papules on the arms and legs that he describes as “itchy.”

Four days previously, the boy had rhinorrhea and cough with a low-grade fever. There is no history of travel, but you note mild generalized lymphadenopathy. Also, his older sibling had rhinorrhea last week.

What is your diagnosis?

1. Insect bites
2. Gianotti-Crosti syndrome
3. Drug reaction
4. Allergic contact dermatitis

Answer

The answer is Gianotti-Crosti. This eruption is often associated with a virus and can be considered a virus-associated exanthem. The condition is most often seen in children between the ages of 2 and 6, and it could last between six and eight weeks.

Generalized lymphadenopathy may be seen, and this condition is infrequently pruritic.

Clinical findings often associated with Gianotti-Crosti include papular lesions, urticarial lesions, and less often, vesicular or papulovesicular lesions. It is often concentrated on the arms and legs, but may be seen on the trunk in a less dense form.

Viruses associated with Gianotti-Crosti include Epstein-Barr; hepatitis A and C; cytomegalovirus; human herpesvirus 6; Coxsackievirus A16, B4 and B5; rotavirus and parvovirus B19. Also, respiratory syncytial virus, echovirus, rubella, parainfluenza and HIV have been associated with Gianotti-Crosti.

Bacteria have also been associated with this syndrome, including Bartonella henselae, beta-hemolytic streptococci, Borrelia Burgdorferi and Mycoplasma pneumoniae.

The syndrome has been reported following some immunizations; however, it is not a contraindication to giving vaccines.

Treatment for the condition includes topical corticosteroids and oral antihistimaines if the patient has pruruitis.

Editor’s note: This case was presented by Dr. Treadwell at the 19th Annual Infectious Diseases in Children Symposium New York.

For more information:

• Brandt O, et al. Gianotti-Crosti syndrome. J Amer Acad Dermatol. 2006;54:136-145.
• Tilly JJ, et al. Lichenoid eruptions in children. J Am Acad Dermatol. 2004;51:606.