| The
Gianotti-Crosti Syndrome./ Acrodermatitis de Gianotti-Crosti. Data-Medicos
Dermagic/Express No. 72
08 Septiembre 1.999. 08 September 1.999.
~Acrodermatitis de Gianotti-Crosti~
~ The Gianotti-Crosti Syndrome ~
EDITORIAL ESPANOL
=================
Hola amigos DERMAGICOS, el tema de hoy: ACRODERMATITIS DE GIANOTTI CROSTI.
En el año de 1.955 Gianotti y posteriormente en 1.956, Gianotti y Crosti describieron esta enfermedad cutanea asociada a hepatitis B, con las siguientes caracteristicas distintivas:
1.) Exantema papular liquenoide no recurrente, simetrico, no pruritico de
aparicion subita localizado en cara, miembros y gluteos.
2.) Linfadenopatia leve generalizada.
3.) Hepatitis aguda anicterica, con antigenemia B de supeificie.
4.) Niños.
5.) Otras: febricula, malestar general, y antecedentes de sintomas del
tracto respiratorios superior.
Y la llamaron Acrodermatitis de la Infancia o ENFERMEDAD de Gianotti y
Crosti. Luego de esta descripción, se presentaron otros casos donde se encontro asociación con otros Agentes VIRALES: Epstein-Barr, Coxsackie, parvovirus B19, parainfluenza, Hepatitis A, Rotavirus, Citomegalovirus, HIV, virus sincisial respiratorio (RSV) y Agentes NO VIRALES: estreptococo Beta hemolitico del grupo A. Tambien se le denomino: sindrome
papulovesicular infantil acro-localizado, y acrodermatitis liquenoide infantil.
En el año de 1.977 se describen 3 casos en Adultos. En 1.979 Gianotti hace
una revision del tema y hace una distincion: entre la ENFERMEDAD
originalmente descrita la cual insiste en denominar ACRODERMATITIS DE LA
INFANCIA O "ENFERMEDAD" DE Gianotti- Crosti, y todos aquellos otros casos
descritos los denomino "SINDROME" de Gianotti-Crosti. Esta controversia
persiste hasta nuestros dias, y tal ha sido la confusion que encontramos
descripciones de "SINDROME" y "ENFERMEDAD" atribuidos a la misma
descripcion, de una misma patologia.
Independientemente de que estos investigadores se hayan inmortalizado con
este descubrimiento pienso que se deberian UNIFICAR CRITERIOS.
Yo propondria llamarla: ACRODERMATITIS DE GIANOTTI-CROSTI O SINDROME DE GIANOTTI-CROSTI, eliminaria el termino "ENFERMEDAD",y agregaria a los criterios originales:
1.) Exantema papular liquenoide no recurrente, simetrico, no pruritico de
aparicion subita localizado en cara, miembros y gluteos.
2.) Linfadenopatia leve generalizada.
3.) Hepatitis aguda anicterica, con antigenemia B de supercifie. (no necesariamente)
4.) Asociación con OTROS VIRUS O AGENTES NO VIRALES.
5.) Niños o ADULTOS.
6.) Otras: febricula, malestar general, y antecedentes de sintomas del
tracto respiratorios superior.
Y la ubicaria en el capitulo de las MANIFESTACIONES CUTANEAS OCASIONADAS
POR AGENTES VIRALES O NO VIRALES.
Espero que disfruten estas 41 referencias bibliograficas.
Bienvenido a DERMAGIC/EXPRESS Dr: Joseph Eastern, MD (USA)
Saludos a todos !!!
Dr. Jose Lapenta R.,,,
EDITORIAL ENGLISH
=================
Hello DERMAGIC friends , today's topic: THE GIANOTTI CROSTI SYNDROME
In the year of 1.955 Gianotti and later on in 1.956, Gianotti and Crosti
they described this cutaneous illness associated to hepatitis B, with the
following ones characteristic distinctive:
1.) A non recurrent, symmetric, nonpruritic papular lichenoid exanthem of
sudden onset, localized to the face, limbs, and buttocks
2.) Mild, generalized limphadenopathy
3.) Acute anicteric hepatitis with hepatitis B surface antigenemia.
4.) Childrens.
5.) Others: Low-grade fever. malaise, and antecedent upper repiratory tract
symptoms.
And called it Acrodermatitis of the Childhood or The Gianotti-Crosti
DISEASE. After this description, other cases were presented in association with other VIRAL Agents: Epstein-Barr, Coxsackie, parvovirus B19, parainfluenza, Hepatitis A, Rotavirus, Cytomegalovirus, VIH, respiratory syncytial virus (RSV); and NON VIRAL Agents: A beta-hemolytic streptococci. is Also denominated: Infantile acro-localized papulovesicular syndrome, Infantile lichenoid acrodermatitis.
In the year of 1.977 3 cases are described in Adults. In 1.979 Gianotti
makes a revision of the topic and he makes a distinction: among the
originally described DISEASE which insists on denominating ACRODERMATITIS
OF THE CHILDHOOD OR Gianotti - Crosti DISEASE, and all those other
described cases he denominate SYNDROME of Gianotti-Crosti. This controversy
persists until our days, and such it has been the confusion that we find
descriptions of " SYNDROME " and " DISEASE" attributed to the same
description, of oneself pathology.
Independently that these investigators have been immortalized with this
discovery I think that it should BE UNIFIED APPROACHES.
I would propose to call it: ACRODERMATITIS OF GIANOTTI-CROSTI, OR GIANOTTI-CROSTI SYNDROME, I would eliminate the term "DISEASE", and would add to the original characteristics:
1.) A non recurrent, symmetric, nonpruritic papular lichenid exanthem of
sudden onset, localizad to the face, limbs, and buttocks
2.) Mild, generalized limphadenopathy
3.) Acute anicteric hepatitis with hepatitis B surface antigenemia, (not necessarily)
4.) Association with OTHER VIRUSES OR NON VIRAL AGENTS.
5.) Childrens. OR ADULTS
6.) Others: Low-grade fever. malaise, and antecedent upper repiratory tract
symptoms.
And it would locate it in the chapter of the CUTANEOUS MANIFESTATIONS FOR
VIRAL OR NOT VIRAL AGENTS.
I hope you enjoy these 41 bibliographical references.
WELCOME to DERMAGIC/EXPRESS Dr: Joseph Eastern, MD (USA)
Greetings to ALL, !!
Dr. Jose Lapenta R.,,,
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REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES
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1.) Rilievi di una particolare casistica tossinfectiva caratterizzata de eruzione eritemato-infiltrativa desquamativa a focolai lenticolari. a sede electiva acroesposta.
2.) Dermatosis infantile erutiva acroesposta di probable origine virosica.
3.) Gianotti-Crosti syndrome.
4.) Acrodermatitis of chilhood and other papovesicular acro-located Syndromes.
5.) On infantile papular acrodermatitis (Gianotti disease) and infantile papular-similvesicular acrodermatitis (Gianotti syndrome).
6.) Infantile lichenoid acrodermatitis. Report of a case of Gianotti-Crosti syndrome.
7.)Detection of hepatitis B surface antigen subtype adr in an epidemic of papular acrodermatitis of childhood (Gianotti's disease).
8.) Gianotti-Crosti syndrome: clinical, serologic, and therapeutic data from nine children.
9.) [Adult papular acrodermatitis (Gianotti's disease). Report of 3 cases]
10.) A 24 cases of human parvovirus B19 infection in children].
11.) [An association between hepatitis-B antigen-negative infantile papular acrodermatitis and Epstein-Barr virus infection].
12.) Gianotti-Crosti syndrome associated with infections other than hepatitis B.
13.) [Infantile acro-localized papulovesicular syndrome].
14.) Gianotti-Crosti syndrome: a study of 26 cases.
15.) Papular acrodermatitis of childhood associated with hepatitis A virus infection.
16.) [Gianotti-Crosti syndrome. HBsAG-negative papular acrodermatitis, an infantile papulovesicular acrolocalized syndrome].
17.) [Pediatric papular acrodermatitis and double primary infection by the hepatitis B virus and the Epstein-Barr virus].
18.) Gianotti-Crosti syndrome. A review of ten cases not associated with hepatitis B.
19.) [Acrodermatitis papulosa eruptiva infantum and Epstein-Barr virus infection].
20.) Infantile papular acrodermatitis (Gianotti's disease) and
intrafamilial occurence of acute hepatitis B with jaundice: age dependency of clinical manifestations of hepatitis B virus infection.
21.) Immune response to hepatitis B virus in children with papular acrodermatitis.
22.) An epidemic of infantile papular acrodermatitis (Gianotti's disease) in Japan associated with hepatitis-B surface antigen subtype ayw.
23.) [Entity of the Gianotti-Crosti's syndrome and its relation to hepatitis B infection].
24.) [Gianotti-Crosti syndrome in Epstein-Barr virus infection]
25.) Gianotti-Crosti syndrome associated with Epstein-Barr virus infection.
26.) Gianotti-Crosti syndrome associated with cytomegalovirus infection: report of one case.
27.) Gianotti-Crosti syndrome and human immunodeficiency virus infection [see comments].
28.) An epidemic of infantile papular acrodermatitis (Gianotti-Crosti syndrome) due to Epstein-Barr virus.
29.) Papular acrodermatitis of childhood (Gianotti-Crosti disease).
30.) Gianotti-Crosti syndrome associated with Epstein-Barr virus infection.
31.) Gianotti-Crosti syndrome associated with hepatitis B surface antigen (subtype adr).
32.) Gianotti-Crosti syndrome. Non-parenterally acquired hepatitis B with a distinctive exanthem.
33.) Gianotti-Crosti syndrome: a retrospective analysis of 308 cases.
34.) Gianotti-Crosti syndrome. A review of ten cases not associated with hepatitis B.
35.) Infantile papular acrodermatitis (Gianotti's disease) and intrafamilial occurence of acute hepatitis B with jaundice: age dependency of clinical manifestations of hepatitis B virus infection.
36.) The Gianotti-Crosti syndrome.
37.) An epidemic of infantile papular acrodermatitis (Gianotti's disease) in Japan associated with hepatitis-B surface antigen subtype ayw.
38.) [Entity of the Gianotti-Crosti's syndrome and its relation to hepatitis B infection]
39.) Papulovesicular acrolocalized syndrome.
40.) Gianotti-Crosti syndrome related to rotavirus infection.
41.) [Syndrome of Gianotti-Crosti associated with hepatitis caused by Coxsackie B4 virus].
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1.) Rilievi di una particolare casistica tossinfectiva caratterizzata de
eruzione eritemato-infiltrativa desquamativa a focolai lenticolari. a sede
electiva acroesposta.
G. Ital Dermatol 1955;96:678-97
Gianotti F.
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2.) Dermatosis infantile erutiva acroesposta di probable origine virosica.
Minerva Dermatol 1956;3(suppl):483-6
Crosti A. Gianotti F.
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3.) Gianotti-Crosti syndrome.
SOURCE: Br J Dermatol (England), May 1968, 80(5) p342-3
AUTHOR(S): Gianotti F
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4.) Acrodermatitis of chilhood and other papovesicular acro-located Syndromes.
Br J Dermatol 1979;100:49-59
Gianotti F.
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5.) On infantile papular acrodermatitis (Gianotti disease) and infantile
papular-similvesicular acrodermatitis (Gianotti syndrome).
SO - J Dermatol 1975 Mar;2(1):5-14
AUTHOR(S): Endo M; Mori H; Morishima T
PT - JOURNAL ARTICLE
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6.) Infantile lichenoid acrodermatitis. Report of a case of Gianotti-Crosti
syndrome.
SO - Arch Dermatol 1965 Oct;92(4):398-401
AUTHOR(S): Endo M; Mori H; Morishima T
PT - JOURNAL ARTICLE
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7.)Detection of hepatitis B surface antigen subtype adr in an epidemic of
papular acrodermatitis of childhood (Gianotti's disease).
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Acta Med Okayama 1981 Dec;35(6):407-10
Kanzaki S, Kanda S, Terada K, Nohno S, Kumano K, Narahara K, Hayashi H,
Kimoto H
Papular acrodermatitis of childhood (PAC) has recently been reported to be
associated with hepatitis B surface antigen (HBsAg) subtype ayw. Between
September, 1978, and June, 1979, we saw 14 patients with PAC in a small
epidemic occurring in Iwakuni City, Japan. HBsAg was detected in sera from
all patients. Subtyping of HBsAg in 11 patients showed that 8 had a
determinant adr and 3 had no detectable determinant because of low antigen
titers. The result suggests that factors other than the specific HBsAg
subtype contribute to the development of PAC.
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8.) Gianotti-Crosti syndrome: clinical, serologic, and therapeutic data
from nine children.
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Cutis 1998 Dec;62(6):271-4; quiz 286
Boeck K, Mempel M, Schmidt T, Abeck D
Department of Dermatology and Allergy Biederstein, Technical University
Munich, Germany.
Gianotti-Crosti syndrome (GCS), a self-limiting papulovesicular
acrodermatitis often associated with underlying viral infection, is mainly
described in children. Nine children with GCS were evaluated with
dermatologic examination and serologic tests for viral infections. Therapy
was modified according to the subjective symptoms of patients, which
included characteristic acrolocated papulovesicles, generalized skin
eruption, and mild to severe pruritus. Results of serologic investigations
revealed Epstein-Barr virus, Coxsackie A virus, parvovirus B19, and
parainfluenza virus 1/2. In three children no underlying viral infection
was found. Therapeutic interventions included topical clioquinol lotion 1
percent, topical application of corticosteroids, systemic antihistaminic
therapy, and systemic methylprednisolone. Skin lesions resolved after 2 to
4 weeks in treated as well as in nontreated children. Although GCS in
children often lacks close association with a causative viral infection,
such severe infections as hepatitis B and human immunodeficiency virus must
be considered. Whole-body involvement seems to correlate with severe
pruritus and additional general symptoms requiring more intensive therapy.
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9.) [Adult papular acrodermatitis (Gianotti's disease). Report of 3 cases]
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TT - [Acrodermatite papuleuse de l'adulte. A propos de 3 cas]
SO - Ann Dermatol Venereol 1977 Mar;104(3):190-4
AUTHOR(S): Claudy AL; Ortonne JP; Trepo C; Bugnon B
MC - English Abstract
PT - JOURNAL ARTICLE
AB - The authors report three cases of adult papular acrodermatitis with
circulating HBs antigen. The eruption was followed by a benign icteric
hepatitis which lasted from 30 to 45 days. In two cases, HBs antigen
disappeared in a one month period, in one case the antigen has been present
for more than three months. Direct immunofluorescence staining exhibits c3
deposits in the vessels of the dermal lesions, without any deposition of
immunoglobulins or fibrinogen. We were unable to demonstrate the presence
of HBs and " e " antigens in the skin lesions (using FITC conjugated
specific antiserums). Serum protein concentrations of complement components
C1q, C4,C3, C3PA were normal as measured by radial immunodiffusion. The
percentage of circulating B and T cells was normal, as essayed by E-RFC,
EAC-RFC and sIg. Thus, adult papular acrodermatitis, as well as the
infantile form, does represent a sign of invasion of a benign viral hepatitis.
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10.) A 24 cases of human parvovirus B19 infection in children].
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Ann Pediatr (Paris) 1992 Nov;39(9):543-9
[Article in French]
Borreda D, Palomera S, Gilbert B, Lienhardt A, de Lumley L
Services de Pediatrie I, CHU Dupuytren, Limoges.
From January 1, 1987 through December 31, 1990, twenty-four pediatric
patients with human parvovirus B19 (HPV B19) infection were seen. In every
case the diagnosis was established by a positive capture immunoassay for
IgM antibodies against the HPV B19. Four patients had hematologic
manifestations, including one case of transient bone marrow aplasia
revealing hereditary spherocytosis, one case of autoimmune hemolytic anemia
with beta-thalassemia, and two cases of peripheral thrombocytopenia. Eight
patients had skin lesions, with a morbilliform rash in six cases, erythema
nodosum in one case, and Gianotti-Crosti syndrome in one case. No patients
had erythema infectiosum. Seven patients developed joint manifestations:
Henoch-Schonlein purpura in two cases, arthralgia in four cases, and
polyarticular disease progressing to severe rheumatoid arthritis in a
thirteen-year-old girl. Unremarkable symptoms of viral disease were seen in
three patients. A five-month-old infant developed severe acute myocarditis.
One patient with hepatitis A had acute liver failure. This study confirms
the broad spectrum of clinical manifestations of HPV B19 infection. There
were a number of unusual findings, including the high rate of joint
manifestations (29%) and the severe course of some hematologic and
myocardial manifestations. These results raise the question of whether the
HPV B19 may be involved in the genesis of chronic juvenile arthritis.
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11.) [An association between hepatitis-B antigen-negative infantile papular
acrodermatitis and Epstein-Barr virus infection].
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[Article in Japanese]
Hokkaido Igaku Zasshi 1989 Mar;64(2):125-38
Konno M
Department of Pediatrics, Hokkaido University School of Medicine.
The virological studies on 23 patients with infantile papular
acrodermatitis (IPA) without hepatitis B virus (HBV)-associated antigens
and antibodies were performed. The following results were obtained; 1)
There was serological evidence of primary Epstein-Barr virus (EBV)
infection in 17 out of 23 cases (74%). 2) The regression assays was done in
5 cases of IPA and 10 cases of infectious mononucleosis known to be
associated with primary EBV infection in order to investigate the
development of EBV-specific killer T cell activity in the primary EBV
infection. The results confirm the evidence for EBV-specific cellular
immunity in both patients with IPA and infectious mononucleosis. 3) The in
vitro transformation assays was also done in 4 cases of IPA and 10 cases of
infectious mononucleosis. Incidence of in vitro spontaneous transformation
in the presence of cyclosporin A was significantly higher in patients of
IPA and infectious mononucleosis than in the EBV seropositive controls.
These results confirm that EBV plays an important role on the pathogenesis
of HBV-negative IPA.
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12.) Gianotti-Crosti syndrome associated with infections other than
hepatitis B.
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JAMA 1986 Nov 7;256(17):2386-8
Draelos ZK, Hansen RC, James WD
Although the Gianotti-Crosti syndrome (GCS) is regularly associated with
hepatitis B infection elsewhere, in North America that association is
rarely made. Accordingly, we studied nine children with acral, symmetrical
eruptions typical of GCS for evidence of other infections. All were
negative for hepatitis B surface antigen. Viral cultures were done in nine
patients, and viruses isolated in two. One patient with a respiratory
prodrome had respiratory syncytial virus (RSV) isolated, and a second
patient studied simultaneously showed serological evidence of RSV
infection. A third patient with both respiratory tract and gastrointestinal
tract symptoms yielded a polio-vaccine enterovirus. Two patients with fever
and pharyngitis had group A beta-hemolytic streptococci isolated from the
throat. Skin biopsies were done in three cases, and findings were
consistent with GCS. Electron microscopy of two lesional biopsy specimens
failed to demonstrate viral particles. Epstein-Barr virus serological
findings were negative in six cases and showed evidence of past infection
in three cases. This study strengthens the observation that hepatitis B is
not the causative agent of GCS in this country and suggests that multiple
infectious agents may be associated with this distinctive exanthem.
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13.) [Infantile acro-localized papulovesicular syndrome].
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Dtsch Med Wochenschr 1986 Sep 26;111(39):1482-4
[Article in German]
Schmidt KU, Hoting E, Mensing H, Nasemann T
Papular acrodermatitis (Gianotti-Crosti syndrome) was seen in a
six-year-old girl. The disease was marked by the characteristic triad of a
papular-vesicular rash, lymphadenopathy and liver damage. Serological
findings suggest an infection with Epstein-Barr virus as the causative
factor. In such cases hepatitis-B induced papular eruptive acrodermatitis
should be considered in differential diagnosis.
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14.) Gianotti-Crosti syndrome: a study of 26 cases.
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Br J Dermatol 1986 Jul;115(1):49-59
Taieb A, Plantin P, Du Pasquier P, Guillet G, Maleville J
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.
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15.) Papular acrodermatitis of childhood associated with hepatitis A virus
infection.
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Pediatr Dermatol 1985 Nov;3(1):31-3
Sagi EF, Linder N, Shouval D
A 2-year-old girl developed an erythematous papular eruption on her face
and extremities a week after an epidemic of hepatitis A had occurred in her
school. Clinical and laboratory signs of acute hepatitis, together with
serologic verification, confirmed hepatitis A infection. That diagnosis
should be considered in the etiology of papular acrodermatitis of childhood.
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16.) [Gianotti-Crosti syndrome. HBsAG-negative papular acrodermatitis, an
infantile papulovesicular acrolocalized syndrome].
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Monatsschr Kinderheilkd 1985 Feb;133(2):111-3
Article in German
Ehringhaus C, Happle R, Dominick HC, Brune KH
We report three cases of the Gianotti-Crosti syndrome
(papulovesicular-acro-located syndrome of childhood), a self-limited common
disease of childhood, which may be caused by various viral infections. The
hepatitis B virus, however, is excluded by definition as a causal agent.
The syndrome is characterized by itching papulo-vesicular skin lesions
measuring 1-5 mm in diameter and localized to the limbs and face. The
clinical and terminological differences between the HBsAG negative
Gianotti-Crosti syndrome and the HBsAG positive Gianotti disease are
emphasized.
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17.) [Pediatric papular acrodermatitis and double primary infection by the
hepatitis B virus and the Epstein-Barr virus].
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Ann Dermatol Venereol 1985;112(11):889-92
[Article in French]
Taieb A, Pompougnac E, Hans P, Fontan I, Maleville J
A case of papular infantile acrodermatitis was evaluated in a twenty-two
month-old child. Laboratory data showed the presence of a cytolytic
hepatitis associated to an increase in circulating monocytes (1.500/mm3)
with hyperbasophilic cells. Hepatitis B surface (HBs) antigen was detected
in the serum, associated to anti-HBc antibodies of the IgM class, without
detectable anti-HBs antibodies. Simultaneously, EBV serologic profiles were
consistent with a primary infection. The authors review the clinical
presentation of previously described cases according to their suspected
cause, and discuss the etiologic role of both EBV and HBV in the hereby
reported case.
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18.) Gianotti-Crosti syndrome. A review of ten cases not associated with
hepatitis B.
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Arch Dermatol 1984 Jul;120(7):891-6
Spear KL, Winkelmann RK
Studies of data from ten cases of infantile acrodermatitis and from eight
cases reported in the North American literature disclose distinctive
papular dermatosis of the face and extremities, often related to virus
infection. None of our eight patients who were tested had evidence of
hepatitis B infections, although transaminase values were elevated in two.
All five patients who were tested had lymphocytosis. Six patients had
antecedent upper respiratory tract symptoms. Data from our cases and from
the other previously reported cases indicate that the eruption is a
virus-related response. Although the hepatitis virus has been the most
frequently encountered causative agent to date, other viruses, including
Epstein-Barr virus, coxsackievirus, and parainfluenza virus, may produce a
similar cutaneous response.
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19.) [Acrodermatitis papulosa eruptiva infantum and Epstein-Barr virus
infection].
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Hautarzt 1984 Feb;35(2):97-9
[Article in German]
Gengoux P, Vincke P, Tennstedt D, Lachapelle JM
A typical Gianotti-Crosti syndrome was observed in an 18-month-old boy.
This infantile papular acrodermatitis was associated with Epstein-Barr
virus but also with B-antigen-negative hepatitis. Biological and
serological parameters have been followed up during the course of the
illness.
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20.) Infantile papular acrodermatitis (Gianotti's disease) and
intrafamilial occurence of acute hepatitis B with jaundice: age dependency
of clinical manifestations of hepatitis B virus infection.
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J Infect Dis 1978 Aug;138(2):211-6
Toda G, Ishimaru Y, Mayumi M, Oda T
Infantile papular acrodermatitis (IPA, Gianotti's disease) is a clinical
manifestation of hepatitis B virus (HBV) infection in childhood. An
epidemic of of IPA occurred in Matsuyama, Japan, where 153 patients in a
pediatric clinic had IPA between October 1974 and March 1977. In this
period 12 mothers and two fathers of patients contracted acute hepatitis B
with overt jaundice three to 14 months after their offspring had IPA.
Analysis of the subtype of hepatitis B surface antigen (HBsAg) in the
infants and their jaundiced mothers and/or fathers disclosed that HBV was
transmitted from the infants. All of the index cases were one year old or
younger, although the age of patients with IPA ranged from three months to
10 years. In approximately 40% of patients with IPA who were one year old
or younger, HBs antigenemia persisted for one year. These facts suggested
that the contraction of IPA in children, especially those one year old or
younger, was an important route toward establishment of the carrier state
of HBV which maintains the reservoir of this virus in the community.
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21.) Immune response to hepatitis B virus in children with papular
acrodermatitis.
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Gastroenterology 1977 Nov;73(5):1103-6
Colombo M, Gerber MA, Vernace SJ, Gianotti F, Paronetto F
Papular acrodermatitis of childhood (PAC) is characterized by papular
eruption of skin, lymphadenopathy, and acute hepatitis B surface antigen
(HBsAg)-positive anicteric hepatitis. To study the course of hepatitis B
virus infection we followed 16 patients with PAC, 2 to 7 years of age, for
periods ranging from 6 to 46 months. All patients tested developed
hepatitis B surface antigenemia subtype ay, and produced antibody to
hepatitis B core antigen with the highest incidence after 3 to 5 months.
Half of the children investigated developed antibody to hepatitis B surface
antigen 4 to 18 months (mean, 6.5) after the onset of PAC. At the end of
the investigation, 31% of the children were still HBsAg-positive, 50% were
antibody to hepatitis B core antigen-positive, and in 43% the activity of
serum aminotransferases was abnormal. Liver biopsy repeated in 2 children
showed chronic aggressive hepatitis. The pattern of antibody response to
hepatitis B virus is similar in both HBsAg-positive hepatitis and PAC. The
frequent development of HBSAg carrier state and the high proportion of
children with liver abnormalities at the end of the investigation suggest
an impaired clearance of hepatitis B virus and a tendency to chronicity.
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22.) An epidemic of infantile papular acrodermatitis (Gianotti's disease)
in Japan associated with hepatitis-B surface antigen subtype ayw.
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Lancet 1976 Apr 3;1(7962):707-9
Ishimaru Y, Ishimaru H, Toda G, Baba K, Mayumi M
An epidemic of infantile papular acrodermatitis (I.P.A.) (Gianotti's
disease) occurred in Matsuyama City, in south-east Japan in 1974-75.
Patients ages ranged from less than one year to eight years. Hepatitis-B
surface antigen (HBsAg) was detected by an immune adherence
haemagglutination method in the serum samples of 48 of the 54 patients
tested. HBsAg subtypes were determined by a haemagglutination-inhibition
method. ayw antigens were identified in 42 patients and adr antigens in 3;
it was not possible to determine subtypes in the remaining 3 patients
because antigen titres were too low. Since subtype ayw and I.P.A. are
extremely rare in Japan, the association of the disease with HBsAg subtype
ayw is regarded as being most significant.
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23.) [Entity of the Gianotti-Crosti's syndrome and its relation to
hepatitis B infection].
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Hautarzt 1975 Sep;26(9):471-9
[Article in German]
Milbradt R, Nasemann T
6 cases of acrodermatitis papulosa eruptiva infantum (acrodermatitis
papulosa infantilis or Gianotti-Crostisyndrome: G.C.S.) were observed and
the clinical features of this disease are discussed. 1. An
erythemato-papular dermatitis mainly of the face, legs, arms, buttocks, not
itching, without re-occurrence lasting on the average 20--25 days. 2. An
distinct enlargement of the lymph nodes, especially of the inguinal and
axillary areas (reactive reticulo-histocytic lymphadenitis). 3. Acute
hepatitis, mostly without icterus. 4. Presence of HB Ag-Australia Antigen
in the serum of patients a few days after the onset of the disease. Doubts
concerning the entity of G.C.S. are getting irrelevant considering the
distinct characteristics. The viral genesis already suggested by Gianotti
and Crosti of the picture of the disease seems to be true: in all cases
Australian antigens are positive. The infectiousness, but the small danger
of infection, even if the disease dates back a few months, should not be
underestimated. When diagnosing G.C.S. among others the akrolocalized
papular-vesicular syndrome described by Crosti and Gianotti should be
considered. In 2 patients we could find by electron microscopic studies
microtubular aggregates having a diameter of 200 A. These aggregates were
situated in the cytoplasm of endothelial cells of smaller vessels in the
upper part of the corium.
====================================================================
24.) [Gianotti-Crosti syndrome in Epstein-Barr virus infection]
====================================================================
TO: Gianotti-Crosti-Syndrom bei Epstein-Barr-Virus-Infektion.
AU: Schopf-RE
AD: Universitats-Hautklinik, Mainz.
SO: Hautarzt. 1995 Oct; 46(10): 714-6
ISSN: 0017-8470
PY: 1995
LA: GERMAN; NON-ENGLISH
CP: GERMANY
AB: Gianotti-Crosti syndrome, a relatively rare, distinctive eruption
occurring after hepatitis B infection, is characterized by a lichenoid
papular exanthema, usually localized on the face, limbs, and buttocks.
Hepatitis B antigenaemia is associated with Gianotti-Crosti syndrome only
in some cases. Recent reports indicate that a variety of infectious agents
are associated with Gianotti-Crosti syndrome. This is a report of 2
1/2-year-old girl with Gianotti-Crosti syndrome and concurrent primary
Epstein-Barr virus infection without evidence of hepatitis B infection.
====================================================================
25.) Gianotti-Crosti syndrome associated with Epstein-Barr virus infection.
====================================================================
Hofmann B; Schuppe HC; Adams O; Lenard HG; Lehmann P; Ruzicka T
Department of Dermatology, Heinrich Heine University, Dusseldorf, Germany.
Pediatr Dermatol (UNITED STATES) Jul-Aug 1997 14 (4) p273-7 ISSN:
0736-8046
Language: ENGLISH
Document Type: JOURNAL ARTICLE
Journal Announcement: 9711
Subfile: INDEX MEDICUS
Gianotti-Crosti syndrome (GCS) is a distinct exanthematic, acrolocated
eruption of
childhood caused by a variety of infectious agents. Historically hepatitis
B antigen
positive (HBsAG+) papular acrodermatitis of childhood and HBsAg negative
(HBsAg-)
papulovesicular acrolocated syndrome have been distinguished. Here we
characterize
the spectrum of associated infectious agents in seven patients with
confirmed GCS
seen in our departments in the years 1994-1995. Where available, stored
frozen serum
samples were reanalyzed for antiviral antibodies. The mean age of the two
girls and
five boys was 22.5 months with a range of 8 to 53 months. None of the
patients was
HBsAG+. Four patients showed serologic evidence of an acute infection and
one
patient of a recent Epstein-Barr virus (EBV) infection. In two additional
children
vaccination preceded the appearance of GCS. In these two patients serologic
investigations revealed no evidence of recent infection with most common
viruses.
Our results underline the role of viral infections other than hepatitis B
in the
etiology of GCS. EBV infection was the most commonly associated viral
disease in our
population. We agree with other authors that we should avoid using the
terms papular
acrodermatitis of childhood and papulovesicular acrolocated syndrome in
describing
====================================================================
26.) Gianotti-Crosti syndrome associated with cytomegalovirus
infection: report of one case.
====================================================================
Au: Tzeng GH; Hsu CY; Chen HC.
Ad: Department of Pediatrics, Taipei Municipal Women's and Children's
General Hospital, Taiwan, R.O.C.
So: Acta Paediatr Sin; 36(2):139-41, 1995 Mar-Apr.
Ab: A one and half a month-old infant, a female, was brought to this
hospital with the chief problem of diarrhea lasting for more than
one week. Four days after admission, symmetric and nonpruritic
lichenoid papules developed over her face and limbs. Physical
examination showed several small palpable lymph nodes over the
bilateral inguinal areas, but without hepatosplenomegaly.
Gianotti-Crosti syndrome was diagnosed. Latter on,
cytomegalovirus (CMV) was isolated from urine and throat swab. It
seemed that this case of Gianotti-Crosti syndrome was associated
with CMV infection (Au).
====================================================================
27.) Gianotti-Crosti syndrome and human immunodeficiency virus infection
[see comments].
====================================================================
Au: Blauvelt A; Turner ML.
Ad: Dermatology Branch, National Cancer Institute, Bethesda, Md.
Cm: Comment in:/Arch Dermatol/1995 Jan;131(1):108-9.
So: Arch Dermatol; 130(4):481-3, 1994 Apr.
Ab: BACKGROUND: Patients with Gianotti-Crosti syndrome (GCS) present with a
distinctive self-limiting acral papular or papulovesicular eruption
associated with an underlying viral illness. Gianotti-Crosti syndrome
in patients infected with human immunodeficiency virus has not been
previously reported. OBSERVATIONS: We report on two children infected
with human immunodeficiency virus who had GCS. Both patients had
clinical and histopathologic findings characteristic of GCS. The first
patient had evidence of prior infection with cytomegalovirus, without
evidence of active viral illness. The second patient had evidence of
subclinical infection with cytomegalovirus, positive hepatitis C
antibody, and active infection with Mycobacterium avium-intracellulare
at the time the skin eruption began. CONCLUSIONS: We call attention to
a previously unreported skin eruption, GCS, in the setting of human
immunodeficiency virus infection and emphasize that determining the
etiologic factors for human immunodeficiency virus-associated GCS will
be difficult; such patients will probably have a variety of clinical
and subclinical infections that complicate this issue (Au).
====================================================================
28.) An epidemic of infantile papular acrodermatitis (Gianotti-Crosti
syndrome) due to Epstein-Barr virus.
====================================================================
SO - Dermatology 1994;188(3):203-4
AU - Baldari U; Monti A; Righini MG
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - Five out of twelve 13- to 15-month-old children, attending the same
class of a creche in Forli (Italy), presented infantile papular
acrodermatitis (Gianotti-Crosti syndrome), associated with lymphocytosis
and evidence for a recent Epstein-Barr virus infection. This cluster may be
due to two facts: (1) the long and close contacts among the patients and
(2) the concurrent immunization with a combined
diphtheria-tetanus-pertussis-poliomyelitis vaccine from 2 to 6 weeks
previously.
====================================================================
29.) Papular acrodermatitis of childhood (Gianotti-Crosti disease).
====================================================================
SO - Pediatr Dermatol 1991 Sep;8(3):224-7
AU - Magyarlaki M; Drobnitsch I; Schneider I
MT - Case Report; Human; Male
PT - JOURNAL ARTICLE
AB - An 11-year-old boy had lentil-sized lichenoid papules, localized to
the limbs and trunk, together with acute, nonicteric, hepatitis B surface
antigen-positive hepatitis. The clinical picture and course were typical of
Gianotti-Crosti disease. Monoclonal antibodies were used to study the
lymphocyte subpopulations and surface antigens in the inflammatory
infiltrate in frozen sections of a skin biopsy specimen. The results
provide data on the pathogenic mechanism of the papular exanthem.
====================================================================
30.) Gianotti-Crosti syndrome associated with Epstein-Barr virus infection.
====================================================================
SO - J Am Acad Dermatol 1989 Feb;20(2 Pt 2):336-8
AU - Lowe L; Hebert AA; Duvic M
MT - Case Report; Female; Human
PT - JOURNAL ARTICLE; REVIEW (15 references); REVIEW, TUTORIAL
AB - Gianotti-Crosti syndrome, a distinctive eruption occurring after
hepatitis B infection, is characterized by symmetric, nonpruritic lichenoid
papules usually localized to the face, limbs, and buttocks. In North
America, hepatitis B antigenemia is rarely associated with Gianotti-Crosti
syndrome in infants. Recent reports indicate there are a variety of
infectious agents associated with Gianotti-Crosti syndrome. We report a
case of an 11-month-old white female infant with Gianotti-Crosti syndrome
and concurrent primary Epstein-Barr virus infection without evidence of
hepatitis B infection.
====================================================================
31.) Gianotti-Crosti syndrome associated with hepatitis B surface antigen
(subtype adr).
====================================================================
SO - J Am Acad Dermatol 1985 Apr;12(4):629-33
AU - Lee S; Kim KY; Hahn CS; Lee MG; Cho CK
MT - Case Report; Human; Male
PT - JOURNAL ARTICLE
AB - The Gianotti-Crosti syndrome, papular acrodermatitis of childhood
(PAC), is an infrequently recognized disorder with distinctive
characteristics. At present hepatitis B virus is thought to be an etiologic
agent. The disease is very rare in Korea, in spite of the high frequency of
hepatitis B surface antigen (HBsAg) in the general population. It is known
that subtype ayw of the HBsAg may influence the pathogenesis of PAC, but
subtype analysis of HBsAg in these patients disclosed adr. Therefore, our
studies reconfirmed that PAC may in addition be associated with subtype adr
of HBsAg. We believe that the lower incidence of PAC in Korea as compared
with the high incidence of PAC in other parts of the world, such as in the
Mediterranean area, may be due to the fact that a higher predisposition to
PAC is conferred by subtype ayw of HBsAg.
====================================================================
32.) Gianotti-Crosti syndrome. Non-parenterally acquired hepatitis B with a
distinctive exanthem.
====================================================================
SO - Med J Aust 1983 Feb 19;1(4):175-6
AU - Fergin P
MT - Case Report; Human; Male
PT - JOURNAL ARTICLE
AB - A case of Gianotti-Crosti syndrome is reported. This condition is an
uncommon form of non-parenterally acquired hepatitis B of children. The
distinctive eruption of Gianotti-Crosti syndrome may be the only symptom or
sign of associated-hepatitis B. Chronic hepatitis may develop in some
patients.
====================================================================
33.) Gianotti-Crosti syndrome: a retrospective analysis of 308 cases.
====================================================================
SO - J Am Acad Dermatol 1992 Feb;26(2 Pt 1):207-10
AU - Caputo R; Gelmetti C; Ermacora E; Gianni E; Silvestri A
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - BACKGROUND: There is no agreement as to whether papular
acrodermatitis of childhood caused by hepatitis B virus can be
differentiated from other papulovesicular acrolocated syndromes. OBJECTIVE:
We attempted to establish whether such differentiation is possible
comparing histories, signs, and symptoms of all patients who have been
previously diagnosed as having papular acrodermatitis of childhood or
papulovesicular acrolocated syndromes. METHODS: Files of 308 patients
hospitalized in the past three decades were studied. Photographs were
examined by a panel of experts to determine whether it was possible to
distinguish between papular acrodermatitis of childhood and papulovesicular
acrolocated syndromes solely on the basis of cutaneous signs. RESULTS: The
retrospective analysis confirmed a significant overlapping of the two types
of the disease. The blind survey of photographs of the patients revealed
that a distinction between the forms was not clinically possible.
CONCLUSION: Acrodermatitis is a self-limiting cutaneous response to
different viruses; clinical differences are probably due to individual
characteristics of each patient rather than the causative virus.
====================================================================
34.) Gianotti-Crosti syndrome. A review of ten cases not associated with
hepatitis B.
====================================================================
SO - Arch Dermatol 1984 Jul;120(7):891-6
AU - Spear KL; Winkelmann RK
MT - Female; Human; Male
PT - JOURNAL ARTICLE
AB - Studies of data from ten cases of infantile acrodermatitis and from
eight cases reported in the North American literature disclose distinctive
papular dermatosis of the face and extremities, often related to virus
infection. None of our eight patients who were tested had evidence of
hepatitis B infections, although transaminase values were elevated in two.
All five patients who were tested had lymphocytosis. Six patients had
antecedent upper respiratory tract symptoms. Data from our cases and from
the other previously reported cases indicate that the eruption is a
virus-related response. Although the hepatitis virus has been the most
frequently encountered causative agent to date, other viruses, including
Epstein-Barr virus, coxsackievirus, and parainfluenza virus, may produce a
similar cutaneous response.
====================================================================
35.) Infantile papular acrodermatitis (Gianotti's disease) and
intrafamilial occurence of acute hepatitis B with jaundice: age dependency
of clinical manifestations of hepatitis B virus infection.
====================================================================
SO - J Infect Dis 1978 Aug;138(2):211-6
AUTHOR(S): Toda G; Ishimaru Y; Mayumi M; Oda T
PT - JOURNAL ARTICLE
AB - Infantile papular acrodermatitis (IPA, Gianotti's disease) is a
clinical manifestation of hepatitis B virus (HBV) infection in childhood.
An epidemic of of IPA occurred in Matsuyama, Japan, where 153 patients in a
pediatric clinic had IPA between October 1974 and March 1977. In this
period 12 mothers and two fathers of patients contracted acute hepatitis B
with overt jaundice three to 14 months after their offspring had IPA.
Analysis of the subtype of hepatitis B surface antigen (HBsAg) in the
infants and their jaundiced mothers and/or fathers disclosed that HBV was
transmitted from the infants. All of the index cases were one year old or
younger, although the age of patients with IPA ranged from three months to
10 years. In approximately 40% of patients with IPA who were one year old
or younger, HBs antigenemia persisted for one year. These facts suggested
that the contraction of IPA in children, especially those one year old or
younger, was an important route toward establishment of the carrier state
of HBV which maintains the reservoir of this virus in the community.
====================================================================
36.) The Gianotti-Crosti syndrome.
====================================================================
SO - Pediatrics 1978 Mar;61(3):433-7
AUTHOR(S): Rubenstein D; Esterly NB; Fretzin D
PT - JOURNAL ARTICLE
AB - The Gianotti-Crosti syndrome is an infrequently recognized disorder
with distinctive characteristics. The eruption, which lasts for two to
eight weeks, consists of large, flat-topped, nonpruritic papules on the
face, buttocks, and limbs. Its onset may be preceded by fever and upper
respiratory tract symptoms. Associated findings include generalized
lymphadenopathy, anicteric hepatitis, and HBs antigenemia. Two children
with the syndrome are described to bring this entity to the attention of
pediatricians.
====================================================================
37.) An epidemic of infantile papular acrodermatitis (Gianotti's disease)
in Japan associated with hepatitis-B surface antigen subtype ayw.
====================================================================
SO - Lancet 1976 Apr 3;1(7962):707-9
AUTHOR(S): Ishimaru Y; Ishimaru H; Toda G; Baba K; Mayumi M
PT - JOURNAL ARTICLE
AB - An epidemic of infantile papular acrodermatitis (I.P.A.) (Gianotti's
disease) occurred in Matsuyama City, in south-east Japan in 1974-75.
Patients ages ranged from less than one year to eight years. Hepatitis-B
surface antigen (HBsAg) was detected by an immune adherence
haemagglutination method in the serum samples of 48 of the 54 patients
tested. HBsAg subtypes were determined by a haemagglutination-inhibition
method. ayw antigens were identified in 42 patients and adr antigens in 3;
it was not possible to determine subtypes in the remaining 3 patients
because antigen titres were too low. Since subtype ayw and I.P.A. are
extremely rare in Japan, the association of the disease with HBsAg subtype
ayw is regarded as being most significant.
====================================================================
38.) [Entity of the Gianotti-Crosti's syndrome and its relation to
hepatitis B infection]
TT - [Uber die Entitat des Gianotti-Crosti-Syndroms und seine Beziehung
zur Hepatitis-B-Infektion]
====================================================================
SO - Hautarzt 1975 Sep;26(9):471-9
AUTHOR(S): Milbradt R; Nasemann T
MC - English Abstract
PT - JOURNAL ARTICLE
AB - 6 cases of acrodermatitis papulosa eruptiva infantum (acrodermatitis
papulosa infantilis or Gianotti-Crostisyndrome: G.C.S.) were observed and
the clinical features of this disease are discussed. 1. An
erythemato-papular dermatitis mainly of the face, legs, arms, buttocks, not
itching, without re-occurrence lasting on the average 20--25 days. 2. An
distinct enlargement of the lymph nodes, especially of the inguinal and
axillary areas (reactive reticulo-histocytic lymphadenitis). 3. Acute
hepatitis, mostly without icterus. 4. Presence of HB Ag-Australia Antigen
in the serum of patients a few days after the onset of the disease. Doubts
concerning the entity of G.C.S. are getting irrelevant considering the
distinct characteristics. The viral genesis already suggested by Gianotti
and Crosti of the picture of the disease seems to be true: in all cases
Australian antigens are positive. The infectiousness, but the small danger
of infection, even if the disease dates back a few months, should not be
underestimated. When diagnosing G.C.S. among others the akrolocalized
papular-vesicular syndrome described by Crosti and Gianotti should be
considered. In 2 patients we could find by electron microscopic studies
microtubular aggregates having a diameter of 200 A. These aggregates were
situated in the cytoplasm of endothelial cells of smaller vessels in the
upper part of the corium.
====================================================================
39.) Papulovesicular acrolocalized syndrome.
====================================================================
Cutis (United States), Apr 1985, 35(4) p362-3
AUTHOR(S): Paltzik RL; Aiello AM
PUBLICATION TYPE: JOURNAL ARTICLE
ABSTRACT: A 1-year-old boy with a cutaneous eruption compatible with
papulovesicular acrolocalized syndrome is described. This unusual but
benign entity of early childhood can be differentiated both by its clinical
presentation and appropriate laboratory testing from the two
morphologically similar eruptions: Gianotti-Crosti syndrome and infection
with Coxsackie virus A-16.
====================================================================
40.) Gianotti-Crosti syndrome related to rotavirus infection.
Pediatr Dermatol 1998 Nov-Dec;15(6):485-6
Di Lernia V
====================================================================
====================================================================
41.) [Syndrome of Gianotti-Crosti associated with hepatitis caused by the
Coxsackie B4 virus].
Med Clin (Barc) 1992 Jun 27;99(5):195
[Article in Spanish]
Ruiz de Erenchun F, Roman J, Villaizan C, Quintanilla E
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DATA-MEDICOS/DERMAGIC-EXPRESS No (64) 07/07/99 DR. JOSE LAPENTA R.
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