|LETTER TO EDITOR
|Year : 2014 | Volume
| Issue : 1 | Page : 88-89
A case of Gianotti-Crosti syndrome
Shylaja Someshwar, Hemangi R Jerajani
Department of Dermatology, MGM Medical College, Navi Mumbai, Maharashtra, India
|Date of Web Publication||15-Mar-2014|
201, Pramukh CHS, Plot No. 64-B, Sector-21, Kharghar, Navi Mumbai - 410 210, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Someshwar S, Jerajani HR. A case of Gianotti-Crosti syndrome. Muller J Med Sci Res 2014;5:88-9
A 3-year-old boy presented with asymptomatic, multiple, raised, reddish lesions on the upper and lower extremities and face of 3 weeks duration [Figure 1] which started on the forearms and progressed over a period of about 10 days to involve the legs and face. The condition was not associated with or preceded by fever or other constitutional symptoms. There was no family history of similar complaints. The child had received vaccination appropriate for his age and the onset of lesions was not preceded immediately by a vaccine injection.
On examination, multiple, discrete, reddish papules were observed on the forearms, legs and face while other areas of the body including the trunk, buttocks, scalp, palms and soles were spared. There was no significant lymphadenopathy and systemic examination did not show organomegaly or any other abnormalities.
His complete blood count and liver function tests were within normal limits. Considering Chuh's proposed criteria for the diagnosis of Gianotti-Crosti Syndrome (GCS), a diagnosis of GCS was made.
Reassurance and topical emollient was given. Lesions subsided within 2 weeks without scars. GCS is a clinically distinct, self-limiting, papulovesicular exanthema primarily seen in children first described by Gianotti in 1955.  Though the pathogenic mechanisms in the causation of this syndrome remains unclear, it is thought to be an immune mediated process requiring prior stimulation by immunization, viral or bacterial infection. ,
The initial reports believed that the condition was related to infection with hepatitis B, the later ones showed a host of viral infections such as Epstein Barr virus, cytomegalovirus, parainfluenza virus, respiratory syncytial virus, Mycoplasma pneumonia and Bartonella henselae, to highlight a few, as associations of the condition. 
Reports of GCS occurring from 3 days to 1 month following immunizations including Japanese encephalitis; hepatitis A and B; diphtheria, tetanus, pertussis; Haemophilus influenzae pe B; measles, mumps and rubella; oral polio; influenza; Bacille Calmette Guerin; and diphtheria exist. 
The rash characteristically appears as symmetric, flat-topped pink papules that coalesce, usually involving the cheeks, buttocks and extensor surfaces of arms and legs. The trunk, antecubital and popliteal surfaces, palms, soles and mucosal surfaces are usually spared, but occasionally show lesions.  The lesions which typically persist for 3-6 weeks, are often asymptomatic or slightly pruritic, may be associated with low grade fever, hepatomegaly and lymphadenopathy.  Atypical presentations such as purpuric lesions, Koebner's phenomenon in the lesions  have been reported and even prolonged course of more than 2 months and recurrences which is rare also has been seen.  Laboratory findings are not characteristic. Leukopenia or slight leukocytosis have been associated and histopathology of the skin lesions is non-specific.
As there are no specific investigations to prove this condition and the histopathology remains inconclusive, Chuh et al. proposed the diagnostic criteria in 2001 for the diagnosis of this condition [Table 1]. 
Though the initial description of the criteria was in Chinese children, later its applicability was also tested in a series of 23 Indian children with GCS and 74 controls by Chuh et al. and was found to be applicable. 
The condition has to be differentiated mainly from scabies which has itchy lesions with truncal involvement and a positive family history. Papular urticaria may pose difficulties but itching and urticarial, excoriated lesions are characteristically seen on the exposed parts in this condition. No treatment appears to shorten the course of the condition which is self-limiting.
| References|| |
|1.||Gianotti F. Rilievi di una particolae casistica tossinfettiva caraterizzata de eruzione eritemato-infiltrativa desquamativa a focolai lenticolari, a sede elettiva acroesposta. G Ital Dermatol 1955;69:678-9. |
|2.||Magyarlaki M, Drobnitsch I, Schneider I. Papular acrodermatitis of childhood (Gianotti-Crosti disease). Pediatr Dermatol 1991;8:224-7. |
|3.||Lipsker D, Saurat JH. A new concept: Paraviral eruptions. Dermatology 2005;211:309-11. |
|4.||Atanasovski M, Dele-Michael A, Dasgeb B, Ganger L, Mehregan D. A case report of Gianotti-Crosti post vaccination with MMR and dTaP. Int J Dermatol 2011;50:609-10. |
|5.||Brandt O, Abeck D, Gianotti R, Burgdorf W. Gianotti-Crosti syndrome. J Am Acad Dermatol 2006;54:136-45. |
|6.||Gianotti F. Papular acrodermatitis of childhood and other papulo-vesicular acro-located syndromes. Br J Dermatol 1979;100:49-59. |
|7.||Patrizi A, Di Lernia V, Neri I, Ricci G. An unusual case of recurrent Gianotti-Crosti syndrome. Pediatr Dermatol 1994;11:283-4. |
|8.||Chuh AA. Diagnostic criteria for Gianotti-Crosti syndrome: A prospective case-control study for validity assessment. Cutis 2001;68:207-13. |
|9.||Chuh A, Lee A, Zawar V. The diagnostic criteria of Gianotti-Crosti syndrome: Are they applicable to children in India? Pediatr Dermatol 2004;21:542-7. |