Erythema nodosum in Gianotti–Crosti syndrome associated with cytomegalovirus infection: a case report

Gianotti–Crosti syndrome and erythema nodosum can be triggered by many different infections. These conditions are rare, especially in combination with each other, and therefore require a competent approach to differential diagnosis and identification of the cause. This article describes a case of a rare combination of atypical nodular erythema and Gianotti–Crosti syndrome with cytomegalovirus infection. A 6-year-old patient was under outpatient treatment for acute respiratory viral infections and exanthema. The child had an aggravated family history of atopy. Acute cytomegalovirus infection was laboratory confirmed. The diagnosis was made: “Cytomegalovirus disease. Infantile papular acrodermatitis (Gianotti–Crosti syndrome)”. After 7 days, the symptoms of acrodermatitis resolved, but papular elements persisted and new hyperemic papular-vesicular rashes appeared. After 3 weeks, nodular erythema developed against the background of the existing elements. The clinical diagnosis was: “Erythema nodosum. Cytomegalovirus infection. Infantile papular acrodermatitis”. The diagnosis was confirmed after consultation with a rheumatologist. The prescribed treatment had no effect on the duration of the disease. Unusuality of erythema nodosum was manifested as absence of symptoms of acute respiratory viral infection, joint and muscle pain the day before. The patient was under paediatric care for 3.5 months, by the end of which the papular acrodermatitis and erythema nodosum resolved almost simultaneously. Paediatricians should consider the possibility of combining Gianotti–Crosti syndrome and erythema nodosum for timely diagnosis.