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Gianotti–Crosti syndrome in a postpartum adult

A 28-year-old Hispanic woman who was three weeks postpartum presented with a 5-day history of pruritic rash and a 2-day history of arthralgia and sore throat. Her pregnancy was complicated by pre-eclampsia at term, and she had a Cesarean delivery. The rash first appeared on the shoulders and spread centrifugally to the arms, thighs, and legs. Arthralgia began in the small joints of the hands and progressed to involve the wrists and shoulders. At presentation, the rash involved the extensor arms and legs with monomorphous, edematous, pink papules (3– 4 mm) in a linear configuration (Fig. 1). The trunk was spared. Biopsy specimens were obtained from lesional and perilesional skin on the left arm. Direct immunofluorescence performed on the perilesional specimen was negative for autoimmune blistering disorders. Microscopic examination of a representative lesion showed prominent epidermal spongiosis, papillary dermal edema, and perivascular lymphocytic inflammation involving the superficial and deep dermis (Fig. 2). The clinical and histopathologic features supported a diagnosis of Gianotti–Crosti syndrome (GCS). Serologic testing was negative for Epstein–Barr virus, parvovirus B19, hepatitis B or C, Coccidioides spp., Mycoplasma spp., rapid plasma reagin, Neisseria gonorrhoeae, Chlamydia trachomatis, and Streptococcus spp. An autoimmune evaluation showed normal levels of antinuclear antibody, cyclic citrullinated peptide, C-reactive protein, anti-SSA/Ro antibodies, anti-SSB/La antibodies, and double-stranded DNA. Figure 1 Monomorphous, edematous, pink papules are arranged in a linear configuration, most prominently on the extensor aspects of the bilateral arms