[Papular-purpuric gloves and socks syndrome--a case report]

Papular-purpuric gloves and socks syndrome is a rare manifestation associated with acute seronegative arthritis and skin lesions. It is triggered by a viral infection, most commonly by Human parvovirus B19 or Coxsackie group of viruses, but precise viral diagnosis is not obtained in all cases.

A 54-year old male patient experienced sudden, intense pain and swelling in the carpal area of his left hand. He also presented with unusual skin lesions, and grouped small purpuric-papules on the dorsal side of the left hand. During the next few days, both feet were similarly affected. In the next four weeks, a transient liver damage occurred, with a moderate increase in liver enzymes. Apart from elevated erythrocyte sedimentation rate and fibrinogen levels, other findings were within normal limits (complete blood and reticulocyte count, parameters of rheumatic and autoimmune diseases, abdominal ultrasound scan, radiographs of the chest and of affected hand and feet joints, urethral smears for isolation of trichomonas, yeasts and chlamydia trachomatis, and Syphilis, Borrelia, Toxoplasmosis, and Mycoplasma pneumoniae serology). Apart from positive tests for HPvB19, other viral serology tests were all negative (Coxsackievirus, Adenovirus, Influenza, Hepatitis B and C virus, HIV). The skin lesions resolved in about three weeks, the intensity of joint pain decreased, but lasted for the next 6 months.

The diagnosis of papular-purpuric gloves and socks syndrome was made on the basis of the characteristic clinical picture, and confirmed by virus serology.