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Epstein-Barr virus (EBV) is a human herpesvirus spread in childhood by contact with saliva. In all populations, the great majority of people are infected by middle age. EBV can cause asymptomatic infection, nonspecific symptoms or, especially in adolescents and young adults, the infectious mononucleosis (IM), characterized by pharyngitis, lymphadenopathy, fatigue, and fever. Two main types of skin rashes, accounted as atypical exanthems, occur in patients with acute IM: a faint erythematous maculopapular eruption of 24-48 hours duration (5-15% of the patients) or a pruritic maculopapular rash in almost all patients receiving ampicillin or amoxicillin. Moreover EBV acute infection has been related to other cutaneous manifestations, such as Gianotti-Crosti syndrome, unilateral laterothoracic exanthem (especially in children), and others. In this study, we reported a case of atypical exanthem with an erythematous-papulovesicular pattern in a 22-year-old female patient with IM and performed a review of the literature of the cutaneous and mucosal eruptions occurring during EBV acute infections.

A 7-month-old boy presented with a 6-month history of a skin eruption of the scalp and the diaper area (Fig. 1) resembling seborrheic dermatitis. Since the age of 3 months, he had developed high grade fever, diffuse pruritic skin lesions, stomatitis (Fig. 2), chronic diarrhea, diffuse lymphadenomegaly, and failure to thrive. The parents were nonconsanguineous and no similar disease had ever been reported in the family. Physical examination showed alopecia, generalized lymphadenopathy, and hepatosplenomegaly. The patient's skin was dry with generalized erythematous, scaling pruritic eruptions and small violaceous nodules on the extremities. Laboratory investigations revealed: slight normochromic anemia, leukocytosis (18,000/mm3) with lymphocytosis (42%), and mild eosinophilia (12%); decreased levels of all classes of serum immunoglobulins were observed with normal IgE levels. Examination of phagocytosis, opsonization, and granulocyte chemotaxis revealed no abnormalities. The number of circulating T cells was within normal limits, whereas that of B cells was low. Recall antigens and T- and B-lymphocyte proliferative response to mitogens and Candida albicans proteins resulted in poor stimulation. Chromosomal analysis of mononuclear ceils from the peripheral blood and skin fibroblasts showed a normal male Kariotype, and HLA typing did not reveal any maternal chimerism. A skin biopsy specimen showed satellite cell necrosis of Keratinocytes and a dense lymphohistiocytic and eosinophilic perivascular infiltrate in the dermis. A specimen from a lymph node showed a picture consistent with dermatopathic iymphadenopathy, with an increase of cells with histiocytic appearance and a dense infiltrate of eosinophils. On electron microscopic examination, no cells with Birbeck's granulations were found in the skin infiltrate and lymph nodes. A bone marrow biopsy was normal. One month later the patient developed generalized exfoliative erythroderma with recurrent cytomegalovirus infections and staphylococcal septicemia. Despite antimicrobial and prednisone therapy, the patient died of toxic shock at the age of 9 months. An autopsy showed diffuse lymphohistiocytic infiltration involving the skin and lymph nodes and extreme lymphocytic depletion in the thymus. Meningitis and pneumonia were also present.

Background Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome consisting of acute symmetrical tenosynovitis of the hands and wrists associated with pain and marked pitting edema of the dorsum of the hands or the feet. Persistent rheumatoid factor seronegativity and elevated acute phase reactants are the rule, while radiographic findings are characterized by the absence of bony erosions. The syndrome has occasionally been associated with a wide range of diseases including solid and hematological malignancies, polymyalgia rheumatica, and other inflammatory rheumatic diseases. Methods Two patients with skin eruption on hands and feet associated with arthromyalgias have been investigated to confirm diagnosis of RS3PE and to detect comorbidities. A revision of all the possible medical conditions correlated to RS3PE has been performed. Results We report two cases of RS3PE associated with Parvovirus B19 infection/reactivation. There are very few reports on the association between RS3PE and infectious agents, and in only one case the syndrome has been correlated to parvovirus infection. Conclusions We want to underline the importance for patients with RS3PE to be seen by dermatologists who should become familiar with this syndrome and remark that Parvovirus B19 infection may be a potential cause of RS3PE.

Background. Blastomycosis-like pyoderma is a disorder of uncertain etiology that has been described in association with a variety of underlying conditions, including inflammatory and neoplastic pathologic conditions and in association with a primary immunodeficiency state. The response to therapy, antibiotics in particular, is said to be variable or poor. Methods. We examined two patients with blastomycosis-like pyoderma in whom no underlying pathologic or immunologic abnormalities were found. We treated them with antibiotics according to bacterial resistance tests. In the second case topical disodium chromoglycate was added. Results. Treatment cleared or markedly improved the lesions. Conclusions. Antibiotic treatment guided by susceptibility tests is recommended. The addition of topical disodium chromoglycate may be useful.