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Histopathologic features seen in Gianotti-Crosti syndrome secondary to Epstein-Barr virus
Insights
Gianotti-Crosti syndrome (GCS) associated with Epstein-Barr virus (EBV) shows marked papillary dermal edema and a prominent cytotoxic T cell infiltrate. This suggests cytotoxic T cells may contribute to the characteristic skin findings in EBV-associated GCS.
Area of Science:
- Dermatopathology
- Immunohistochemistry
- Virology
Background:
- Gianotti-Crosti syndrome (GCS), or infantile papular acrodermatitis, is a skin eruption in children.
- It is associated with viral infections, including Epstein-Barr virus (EBV).
Observation:
- This study investigated the immunohistochemical profile of skin lesions in three patients with EBV-associated GCS.
- The researchers examined lymphoid infiltrate patterns and viral antigen presence.
Findings:
- Biopsies revealed marked papillary dermal edema and a mixed mononuclear inflammatory infiltrate.
- Immunohistochemistry showed a predominance of CD8+ cytotoxic T cells, with TIA+ cells corresponding to CD8+ cells.
- EBV antigens were not detected in the skin lesions.
Implications:
- Marked papillary dermal edema is a consistent histologic finding in EBV-associated GCS.
- The significant presence of cytotoxic T cells may be a distinctive feature of EBV-associated GCS.
- These findings enhance understanding of the pathogenesis of GCS.
Background:
Gianotti-Crosti syndrome (GCS) or infantile papular acrodermatitis presents as a symmetric erythematous lichenoid papular and papulovesicular eruption of the face, extremities, and buttocks, usually occurring in young children. GCS has been associated with hepatitis B and enteroviruses, as well as Epstein-Barr virus (EBV) and, rarely, cytomegalovirus.
Objective:
The purpose of this study was to use immunohistochemical studies to determine the pattern of the lymphoid infiltrate and evidence for viral antigens in cases of EBV-associated GCS.
Methods:
Routine histologic and immunohistochemical stains were evaluated in 3 patients with typical GCS. All 3 patients showed serologic evidence of an acute EBV infection. The immunohistochemical studies included monoclonal antibodies for CD3, CD4, CD8, CD20, TIA, S-100 protein, KP-1, EBV latent membrane antigen-1, and EBV-encoded nuclear antigen-2.
Results:
All biopsy specimens showed minimal epidermal spongiosis with marked papillary dermal edema. The associated inflammatory infiltrate showed a mixed mononuclear cell infiltrate with rare eosinophils. Immunohistochemical stains for latent membrane antigen-1 and EBV-encoded nuclear antigen-2 were negative for EBV. The majority of mononuclear cells showed membrane staining for CD3, 30% to 40% of the CD3 mononuclear cells showed positive staining for CD4, and 50% to 60% showed positive staining with CD8. TIA(+) cells appeared to correspond to the CD8(+) cells.
Conclusion:
Although papillary dermal edema has been reported within the spectrum of histologic findings in GCS, it was marked and a consistent finding in the 3 cases in which EBV was the most likely etiologic agent. The presence of large numbers of cytotoxic T cells in the inflammatory infiltrate may have accentuated this histologic finding and may be a relatively distinctive histologic finding with GCS associated with EBV.