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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2001 April;160(2):57-63
Toxoplasmosis and papular acrodermatitis of childhood
Barbosa Vosgerau J. C.
Centro Municipal de Especialidades, Secretariat of Health from Ponta Grossa, Ponta Grossa, Brasil
Gianotti-Crosti syndrome or papular acrodermatitis of childhood (PAC) is an erythemato-papular rash on the face and limbs of children, of unknown cause. As a self-limited disorder, skin rash fades away in about 3 weeks, hepatitis in 2 months. It may be preceded by fever, malaise and respiratory complaints and it may be associated with lymphadenopathy, anicteric hepatitis. HbsAg has been claimed to be always present when exanthema and hepatitis are present, but hepatitis A, coxsackie virus, cytomegalovirus have been implicated in PAC. Toxoplasmosis symptoms are protean and non-specific and may cause myocarditis, meningoencephalitis, hepatitis, skin disorders. From a clinical retrospective study, we report 2 patients with PAC, one of them atopic complicated with hepatitis A and drug-related hepatitis (to corticosteroid) relapsing lasting more than 3 months with IgG and IgE hypergammaglobulinemia and another patient whose clinical deterioration continued for a month that had monocytosis, lymphopenia, neutrophilia, hypocholesterolemia and toxoplasmosis IgG was very high (4,560 and ↑3,000 UI/ml) in both patients. The clinical/laboratory disorders showed marked improvement and/or remitted with anti-toxoplasmosis medicines. It was postulated that IFN-γ high levels has a central role in toxoplasmosis and PAC toxoplasmosis-related pathophysiology. It was concluded: 1) PAC of these patients were a skin manifestation of severe toxoplasmosis. 2) Hepatitis A virus infection is a condition that reinforces immunosuppression induced by severe toxoplasmosis and contributes for PAC to become itself a life-threatening condition. 3) Toxoplasmosis should always be part of the clinical investigation of any hepatitis. 4) As far we are aware toxoplasmosis and cytokines storm were not implicated in PAC pathophysiology until now.