Dr Joepaul, Dr Sathyajith G Nair, Dr Sajitha Nair, Dr C Jayakumar
One yr nine month old male presented with complaints of itchy maculopapular rashes since 1 month to begin with over hands and later spread all over the body
Second day of the illness he had high grade fever for which he git parental antibiotics for three days. Due to persistence he was he shifted to a tertiary hospital where also he was on potential medications,supportives ,oral steroids and discharged after 4 days of hospital stay. On and off fever and itchy rashes were continued in-addition to the skin peeling around all the finger nails ,both palms and had strawberry tongue
All the skin manifestation subsided gradually but to have wet cough, fever and loss of appetite for the next 3 days
At this point he come to our Centre
Febrile and sick looking child is noted to have pleomorphic maculopapular rashes all over the body including the face. Respiratory system examination revealed right sided consolidation and that was managed with parenteral antibiotics
Differential diagnosis:
1.Erythema multiformae
2.Insect bites
3.Langerhans cell histiocytosis
4.Urticaria
5.Atopic dermatitis
6.Erythema infectiosum
Labs were normal except for elevated ESR(51mm/hr).
CXR showed pneumonic patch in right middle lobe.
USG Chest showed consolidation in the right middle lobe corresponding to the radiograph but abdominal USG normal
ASO titre was negative.
TB, Gastric aspirate for GeneXpert and Mantoux test were normal.
RVP was positive for Influenza A(H1N1).
Echo normal.
Skin biopsy showed findings consistent with Gianotti crosti syndrome.
History Pathology
Epidermis showed rete pegs with follicular openings and baskey weave keratin.
Dermis was hyalinised edematous and showed hyalinised vessels with extravasated RBC and perivascular lymphohistocytic infiltrate. Focal periappendageal and perineural infiltrate seen consistent with Gianotti Crosti
Blood and urine cultures were sterile.
Fever subsided during stay in the hospital, however skin lesions persisted. Parents were counselled regarding the persistence of skin lesion in detail.
Child responded well to given treatment and is discharged with stable vitals.
Gionetti crosti syndrome-
It is a self limiting papular acrodermatitis skin disorder most often occurs in young children.
Viral infections are common precipitating factors.
Manifests as symmetric popular eruptions. Classic sites of involvement include cheeks, buttocks, extensor surface of forearms and legs. It may be pruritic or asymptomatic and papules typically resolve spontaneously within 2 months. Patient may experience symptoms of URTI or GI illness during week before onset of illness. Complication include hypo/hyper pigmentation of skin which can persists upto 6 months. Skin biopsy is not necessary but helps in diagnosis.
Take home message- All rashes with periungual peeling and strawberry tongue is not Kawasaki disease or Scarlet fever Detailed history and examination and skin biopsy will help you to reach the correct diagnosis
