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BRIEF REPORT
Article first published online: 6 DEC 2011
DOI: 10.1111/j.1525-1470.2011.01636.x
© 2011 Wiley Periodicals, Inc.
Additional Information
Retrouvey, M., Koch, L. H. and Williams, J. V. (2013), Gianotti–Crosti Syndrome Following Childhood Vaccinations. Pediatric Dermatology, 30: 137–138. doi: 10.1111/j.1525-1470.2011.01636.x
Abstract: A 19-month-old boy was evaluated for a skin eruption after recent vaccinations. Clinical and histopathologic findings supported a diagnosis of Gianotti–Crosti syndrome (GCS). This case report examines the link between GCS and vaccinations, particularly the diphtheria, tetanus, and pertussis vaccine and the varicella virus live vaccine.
In 1955, Gianotti and Crosti described a pediatric dermatosis characterized by skin-colored to erythematous, flat-topped papules that they called papular acrodermatitis of childhood or Gianotti–Crosti syndrome (GCS). GCS is most common in children aged 2–6, with papules measuring 2–5 mm in diameter and distributed symmetrically on the face, buttocks, and extremities. Lesions are typically nonpainful and nonpruritic and resolve within 8–12 weeks. Lymphadenopathy and anicteric acute hepatitis may also be present (1). It has been reported after viral infections as well as after vaccination (Table 1).
| Author | Year | Patients, n | Age (mean or range) | Vaccination | Virus |
|---|---|---|---|---|---|
| |||||
| Spear (6) | 1984 | 10 | 12–96 months | Diphtheria | Epstein-Barr Coxsackievirus Parainfluenza virus |
| Draelos (7) | 1986 | 9 | 13 months–2 1/3 year | Polio-vaccine enterovirus | Respiratory syncytial virus |
| Taieb (1) | 1986 | 26 | 2 years | BCG Combined poliomyelitis, diphtheria, tetanus, pertussis | Ebstein–Barr Coxsackie B Cytomegalovirus |
| Caputo (3) | 1992 | 308 | 6 months–14 years | None | Hepatitis B Cytomegalovirus Ebstein–Barr |
| Blauvelt (8) | 1994 | 2 | 24 months–10 years | None | Human immunodeficiency Cytomegalovirus Hepatitis C |
| Baldari (9) | 1994 | 5 | 13–15 months | Diphtheria, tetanus, pertussis | Ebstein–Barr |
| Lacour (10) | 1995 | 6 | 5 years | MMR | Ebstein–Barr |
| Velangi (11) | 1998 | 1 | 15 months | MMR | None |
| Chuh (12) | 2002 | 10 | 7 months–23 years | None | Human herpesvirus-6 |
| Andıran (2) | 2002 | 1 | 11 months | Measles Hepatitis B | None |
| Kang (13) | 2003 | 1 | 3 years | Japanese B encephalitis | None |
| Kolivras (14) | 2008 | 1 | 18 months | Hepatitis A | None |
A 19-month-old Hispanic boy presented to the emergency department with asymmetrically distributed skin lesions that developed 2 days after immunization with measles, mumps, and rubella vaccine on the right thigh and the varicella virus live vaccine (Varivax) and diphtheria, tetanus, and pertussis (DTaP) vaccines administered on the left thigh. He developed a fever of 39°C the night of the immunizations but then was afebrile. He had no preceding respiratory or gastrointestinal symptoms. Initially, pink papules were noted at and around the site of the injection on the left thigh that coalesced into larger plaques (Fig. 1). Pink macules and edematous papules developed later on the pinna, face, trunk, and right leg. A punch biopsy from the left thigh showed interface dermatitis with perivascular lymphocytes and histiocytes and rare neutrophils and eosinophils. These findings were read as consistent with GCS (Fig. 2).
Figure 1. Pink papules, many of which coalesce into larger plaques, on the left thigh.
Figure 2. A punch biopsy from the left leg demonstrated acanthosis, mild spongiosis, and spongiotic microvesicles containing few lymphocytes. There is prominent basal vacuolization, exocytosis of lymphocytes into the lower epidermis, and edema of the papillary dermis. There is a brisk perivascular infiltrate of mostly lymphocytes and histiocytes with rare neutrophils and eosinophils. These findings support the diagnosis of Gianotti–Crosti syndrome.
Because the major site of involvement was at the site of the injection on the left thigh, we suspected that the DTaP vaccine or the varicella virus live vaccine was responsible for precipitating the skin eruption.
Although GCS was initially described in association with anicteric hepatitis caused by hepatitis B, it has been more commonly associated with other viruses in the United States (Table 1). In addition to viral infections, GCS has been reported to occur after immunization with live, killed, and recombinant vaccines (Table 1). Some authors have suggested that there is a higher risk of GCS lesions with combined vaccinations (2,3). Other authors have suggested that the risk of developing GCS is greater when an active viral infection is present at the time of vaccination (4,5).
It has been suggested that high T-cell reactivity due to preceding infection or preceding vaccination greatly increases the likelihood of developing GCS. Our patient had a history of fever immediately after the vaccination but no fever or other viral symptoms before or at the time of the vaccination.
As the number of childhood immunizations increases, and more combination vaccines are available, perhaps we will see further reports of this postimmunization phenomenon.
