Gianotti–Crosti Syndrome Following Measles, Mumps, and Rubella Vaccination

Dear Editor, Gianotti–Crosti syndrome (GCS) is a self-limiting dermatosis characterized by skin-colored to erythematous flat-topped papules distributed symmetrically on the face, buttocks, and extremities, commonly affecting children between 1 and 6 years of age. We report an 18-month-old male child with an atopic background diagnosed as GCS following measles, mumps, and rubella (MMR) booster vaccination. An 18-month-old male child with a history of atopy in the family presented with generalized itching and symmetrical skin lesions without any prodromal symptoms, predominantly on the extensor aspect of all extremities for 1 month, which developed 3 days following MMR booster immunization given at 1½ years as per the National Immunization Schedule. There was no history of viral infection, drug intake, or any insect bite before the onset of lesions. On examination, the child had multiple, small, skin-colored papules with few papulovesicles predominantly involving his face, buttocks, and upper and lower limbs with minimal trunk involvement [Figure 1a-c]. Oral, genital mucosa, palms, and soles were normal. The child also had small (<1 cm), nontender, firm, and mobile lymph node enlargement in the cervical, axillary, and inguinal regions. Although not clinically significant, this type of reactive lymphadenitis is reported to occur in GCS. The child was nonicteric, and abdominal examination revealed no hepatosplenomegaly. The rest of the systemic examination was normal.Figure 1: Multiple symmetrically distributed erythematous to skin-colored papules, few with central excoriation present (a) over the forehead, (b) over the arm and forearm, and (c) over the thighs and the legsUpon investigation, absolute eosinophil count (3200 µL) and serum immunoglobulin (Ig) E (4502 IU/mL) were elevated. Renal and liver parameters were within normal limits. Skin biopsy revealed dermal perivascular and interstitial mixed inflammation and vasculopathy reaction pattern. A differential diagnosis of GCS and papular urticaria was considered. Considering the patient’s recent vaccination, the characteristics and distribution of the lesions, and the fact that histopathological findings in GCS are often nonspecific, a final diagnosis of GCS was made. The child was managed symptomatically with antihistamines and emollients. Skin lesions and lymphadenopathy resolved completely after 2 months. GCS is a self-limiting dermatosis initially described by Gianotti and Crosti in 1955 who named it “Papular acrodermatitis of childhood.”[1] It commonly affects children of 2–6 years of age. Lesions usually resolve within 8–12 weeks. The precise pathogenesis of GCS is not fully understood, but two primary hypotheses have been proposed. The first suggests an IgE-mediated response, supported by the association of GCS with elevated serum IgE levels and atopy. The second hypothesis involves a local delayed (type 4) hypersensitivity reaction in the dermis to various pathogens and vaccines.[2] Studies suggest that GCS tends to occur in children with a personal or family history of atopy.[3] GCS has been associated with various viral and bacterial infections, including Epstein–Barr virus, Cytomegalovirus, Hepatitis B and C viruses, Adenovirus, Coxsackievirus, Parvovirus B19, as well as bacterial pathogens such as Borrelia burgdorferi, Bartonella henselae, β-hemolytic streptococci, and Mycoplasma pneumoniae. In addition, GCS has occasionally been reported following immunizations, suggesting a potential association with certain vaccines. Vaccines reported to cause GCS include MMR, oral polio vaccine, influenza, Japanese encephalitis, hepatitis A, and DPT vaccines. Only a limited number of case reports document the development of GCS in children following MMR vaccination.[4,5] It is diagnosed by the presence of skin-colored to erythematous flat-topped papules, typically measuring 2–5 mm in diameter and symmetrically distributed on the face, buttocks, and extremities. Systemic symptoms may occur, including mild fever, arthralgia, generalized lymphadenopathy, diarrhea, and hepatosplenomegaly. GCS is usually clinically diagnosed without the need for laboratory tests, as histopathology can be nonspecific. This case highlights the importance of raising awareness of this condition to ensure accurate diagnosis and appropriate management. Recognizing it as a self-limiting disorder is crucial to prevent unnecessary vaccine restrictions in children. Declaration of patient consent The authors certify that they have obtained all appropriate consent forms, duly signed by the parents of the patient. In the form, the parents have given their consent for the images and other clinical information of their child to be reported in the journal. The parents understand that the names and initials of their child/children will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.