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CLINICAL CASES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2001 April;160(2):57-63

Copyright © 2001 EDIZIONI MINERVA MEDICA

language: English

Toxoplasmosis and papular acrodermatitis of childhood

Barbosa Vosgerau J. C.

Centro Municipal de Especialidades, Secretariat of Health from Ponta Grossa, Ponta Grossa, Brasil


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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.

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