Acral Anomaly in a Young Boy
Three-year-old boy has rash x7 days on arms and legs plus low-grade fever x10-14 days. Is the eruption anomaly or simply ordinary?
Patient is a 3-year-old male presenting with asymptomatic rash of 7-days duration; low-grade fever, sore throat x10-14 days. No infectious exposures; PMH noncontributory.
Seen are symmetric flesh-colored flat-topped papules without excoriation; on face, buttocks, limbs. moderately enlarged cervical lymph nodes; palpable spleen tip; lymphocytosis; -strep; +monospot.
Symmetric, flesh-colored monomorphous acral papules on arms and legs.
Monomorphous papules on leg.
Monomorphous papules on arm.
Possible differential diagnosis: Erythema multiforme, fire ant bites, lichenoid reaction to medications, non-specific viral exanthema, papular urticaria, papular acrodermatitis associated with infectious mononucleosis, Rocky Mountain Spotted fever.
More likely differential diagnosis: Erythema multiforme, lichenoid reaction to medications, non-specific viral exanthema, papular acrodermatitis (Gianotti-Crosti syndrome) associated with infectious mononucleosis, Rocky Mountain Spotted fever.
Diagnosis: Gianotti-Crosti syndrome associated with infectious mononucleosis (papular acrodermatitis); lichenoid dermatitis of childhood (3mo - 15y); characteristic acral distribution - arms, legs, buttocks.
Gianotti-Crosti syndrome: Originally associated with hepB, with anicteric presentation. Incidence may parallel incidence of specific local infection.
Gianotti-Crosti Syndrome: Lab workup - hepatitis B; anicteric hepatitis common (LFTs); rash (asymptomatic) lasts from 2 wk – 4 mos. No specific treatment.
Gianotti-Crosti Syndrome: Known causes, among others: hepatitis B, mononucleosis (most common), RSV, rotavirus, Grp A B-strep, HIV, vaccine-related (MMR).
Young boy with Gianotti-Crosti syndrome associated with hepatitis B; presented with monomorphous papules on face, extremities.
Arm of young patient with hepatitis B.
Monomorphous papules on leg of patient with hepatitis B.
In the after-hours clinic you see a 3-year-old boy whose mother is concerned about a papular rash on the child's limbs, present for about 1 week. She also says he's been running a low-grade fever on and off for almost 2 weeks. PMH is non-contributory and there are no known sick contacts.What is your first impression on visualizing the rash? Are laboratory tests indicated? What's your diagnosis? Click through the slides below.Â
