Hemorrhagic Gianotti-Crosti Syndrome in a One and Half Month old Infant: An Extremely Unusual Presentation
A male infant, aged one and half month born vaginally at term following uneventful pregnancy, weighing 2.9 kg at birth and 4.5 kg at presentation, on exclusive breast-feeding, was hospitalized with remittent, moderate fever of 7 days duration and hemorrhagic papulovesicular eruptions for 5 days duration. The baby was found non-toxic. Bowel and bladder function was normal, and the baby was sucking well.\nEruption rapidly involved all 4 limbs and face. There were extensive hemorrhagic vesicles along with papules over hands, feet, lower and upper limbs (mostly on extensor surfaces), face, and lips but sparing other parts of the oral mucosa [Figures and ].\nThere was no icterus or significant lymphadenopathy, but moderate pallor was present. There was mildly enlarged soft spleen (2 cm) and liver (2.5 cm) as found on palpation of abdomen.\nPeripheral blood examination showed low hemoglobin concentration (Hb-8.8%), leukocytosis (20800/cmm) with lymphocytosis (Neutophil-30, Lymphocyte-64). Characteristically, 26% of the total lymphocytic population showed atypicality (mostly plasmacytoid form, a few were monocytoid form) and normal platelet count (2.4 lacs/cmm). Liver and renal function studies and urine examination revealed no abnormality.\nHBsAg was negative. IgM antibody against Epstein Bar viral capsid antigen (VCA) was significantly elevated (IgM-31.51 U/ml, reference range: 0-8 U negative, 8-12 borderline). A diagnosis of Gianotti-Crosti syndrome was made, and causative role of EBV was suggested.\nPatient was treated conservatively with symptomatic measures. Rash started improving from 6th day of admission and resolved completely with mild hypopigmentation and scaling by 11th day. [].