Letters to the Editor

Indian Pediatrics 2000;37: 683-684

Gianotti-Crosti Syndrome

Gianotti-Crosti Syndrome (GCS) is an acrolated exanthematous multi-system entity supposed to be caused by a variety of infections. Various reports have implicated apart from hepatitis B virus. Other causative organisms like Epstein-Barr virus, Herpes virus, cyto- megalo virus, Coxsackie B virus, respiratory syncitial virus, entero virus, parainfluenza virus and possibly some other non viral infectious agents as well.

A 9-year-old male child presented with erythemo-papular rash, fever, high colored urine and mild jaundice. The fever subsided with symptomatic treatment but skin rash which had been present on limbs and face for over two weeks persisted for another two weeks. Examination of the child showed cervical and inguinal lymphadenopathy and abdominal tenderness with mild hepatomegaly. Ultra-sonography confirmed liver enlargement but without any other pathology. Serum bilirubin levels were 2.6 mg/dl with alkaline phosphatase being 1772 IU. The total leukocyte count was 15,600/cu mm. Urine was positive for bile pigments and urobilinogen. SGOT and SGPT values were 84 and 120 IU, respectively. ELISA for Hepatitis A and C was non-reactive while serology for HBsAg was negative. Investigations like urine and blood cultures, paired Widal test and chest skiagram did not reveal any focus of infection elsewhere. History of the patient also did not point to any infective process. A skin biopsy from lesion (Fig. 1) showed upper dermal lympho-histiocytic infiltrate with focal spongiosis and mild acanthosis, thereby confirming the diagnosis of GCS.

The presentation of our patient was characterized by involvement of skin and reticulo-endothelial system with fever which could not be attributed to any specific cause or infection. We could not establish any correlation with infective process in this patient.

Many recent studies(1,2) have failed to attribute any specific infective process in the etiology of GCS. According to one study(3), clinical features of GCS depend on the characteristics of an individual rather than the specific causative response to this condition. Moreover, a distinction cannot be made between cases of viral and non-viral origins since GCS is a self limiting response to different stimuli(3). In this patient the condition could have been due to prior latent or overt infection. We believe that GCS cases are reported infrequently from developing countries despite a greater prevalence of infectious conditions.

Tarsem Jindal,
Senior Consultant,
Department of Pediatrics and Neonatology,

V.K. Arora,
Senior Consultant,
Department of Dermatology,
Jaipur Golden Hospital,
Rohini, Delhi 110 085, India.

1. Taieb A, Plantin P, Du Pasquier P, Guillet G, Maleville J. Gianotti-Crosti Syndrome: A study of 26 cases. Br J Dermatol 1986; 115: 49-59.

2. Draelos ZK, Hansen RC, James WD. Gianotti-Crosti syndrome associated with infections other than Hepatitis B. J Am Med Ass 1986; 256: 2386-2388.

3. Caputo R, Gelmetti C, Ermacosa E, Gianni E, Silvestri A. Gianotti-Crosti Syndrome: A retros-pective analysis of 308 cases. J Am Acad Dermatol 1992; 26: 207-210.