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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Gianotti-Crosti Syndrome &#40;GCS&#41; is a reactive&#44; self-limited condition characterized by a symmetrical papular eruption&#44; that occurs primarily in infants and is most commonly associated with viral infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Here we report a unique case of an adult patient who developed a skin eruption shortly after vaccination against SARS-CoV-2&#44; with clinical and histopathologic findings supporting the diagnosis of GCS&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 35-year-old woman was referred to our Dermatology clinic for a sudden pruritic papular rash&#46; She reported that the skin lesions first appeared over her buttocks&#44; soon spreading to the upper limbs&#44; palms and trunk&#46; Lesions were moderately itchy&#46; Dermatological examination showed a symmetric eruption with erythematous papules&#44; some of which crusted&#44; 2&#8211;4<span class="elsevierStyleHsp" style=""></span>mm in size&#44; mainly affecting the upper limbs&#44; palms and trunk and scarcely the buttocks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#8211;c&#41;&#46; In the extensor surface of the elbows&#44; some confluent papulovesicles were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a and b&#41;&#46; Fever and lymphadenopathy were absent&#46; The patient&#39;s medical history was only remarkable for allergic rhinitis&#46; No history of recent infections or use of oral or topical medication was identified&#46; Ten days prior to the beginning of the eruption&#44; she had received the first dose of SARS-CoV-2 immunization <span class="elsevierStyleItalic">Comirnaty</span>&#174;&#44; a messenger RNA-based vaccine&#46; Histopathological findings&#44; although non-specific&#44; were consistent with those described in GCS &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Symptomatic treatment with antihistamines was prescribed&#46; Complete spontaneous regression of the skin lesions occurred after 12 days&#44; with no scars or altered pigmentation&#46; The second dose of SARS-CoV-2 immunization was administered 21 days after the first one&#44; with no adverse effects reported&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Firstly described by Gianotti and Crosti in the 1950s&#44; GCS is characterized by the acute onset of a symmetrical and monomorphic eruption&#44; with millimetric skin-colored to pink-red flat-topped papules&#44; mainly distributed on the face&#44; buttocks and extensor surfaces of the extremities&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;3</span></a> Palms and soles may also be affected&#46; The trunk is usually spared&#44; although its involvement does not exclude the diagnosis&#46; The lesions can become confluent&#44; mostly over pressure points like knees and elbows and occasionally&#44; may be vesicular&#46; Mild-to-moderate pruritus may be present&#46; Systemic manifestations are unusual and include fever&#44; lymphadenopathy and hepatosplenomegaly&#46; Unusual presentations of GCS have been reported&#44; either by atypical clinical characteristics or location of the skin lesions&#46; Two cases of GCS confined to the face have been reported&#44; as well as a patient with typical GCS lesions accompanied by plantar erythema and desquamation&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#8211;6</span></a> Age&#44; health and vaccination status have been pointed out as potential influencers of clinical presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">GCS primarily affects infants aged between one and six years&#44; rarely occurring in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Although it usually occurs in association with a viral illness&#44; most often by Hepatitis B virus or Epstein&#8211;Barr virus&#44; it is occasionally associated with other pathogens or vaccinations&#46; The precise pathogenesis of GCS is not clear&#44; but it is presumed to be immunologically mediated&#46; Furthermore&#44; it appears that GCS is associated with atopy&#44; due to its increased prevalence in patients with personal and&#47;or family history of atopic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a> The diagnosis is mainly clinical&#44; with no characteristic laboratory features nor specific findings in skin biopsy&#46; Patients may have modest lymphocytosis or lymphopenia and liver enzymes may be elevated&#46; Histopathologic findings can include mild epidermal acanthosis and spongiosis with focal paraketatosis&#44; as well as papillary dermis edema and perivascular lymphocytic infiltrate&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The disease has a benign course&#44; with spontaneous resolution usually within 2&#8211;6 weeks&#46; Post-inflammatory hypo- or hyperpigmentation may follow resolution of the skin lesions&#44; but permanent scarring is uncommon&#46; Symptomatic treatment of the associated pruritus usually suffices&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We highlight the importance of considering GCS in the differential diagnosis of papular eruptions&#44; even in adult patients&#46; During the current COVID-19 pandemic&#44; the reported cases regarding dermatologic manifestations associated to SARS-CoV-2 have been increasing&#44; some of which concern unexpected groups of patients or clinical contexts&#46; There have been two reported cases of GCS in patients with confirmed COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8&#44;9</span></a> We now report a unique case of this dermatological entity&#44; mainly distributed in atypical locations and associated with SARS-CoV-2 vaccination&#44; so far not described in the literature&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">There are no funding sources of this article&#46;</p></span></span>"
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Case and Research Letter
Gianotti-Crosti Syndrome of Atypical Location in an Adult Following SARS-CoV-2 Vaccination
Síndrome de Gianotti-Crosti de localización atípica en un adulto después de la vacunación contra el SARS-CoV-2
M. Pestanaa,
Autor para correspondencia
mafaldambp@gmail.com

Corresponding author.
, R. Araújo Carvalhoa, M.M. Valejo Coelhoa, G. Estevesb
a Dermatology and Venereology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
b Anatomical Pathology Department, Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
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        "titulo" => "S&#237;ndrome de Gianotti-Crosti de localizaci&#243;n at&#237;pica en un adulto despu&#233;s de la vacunaci&#243;n contra el SARS-CoV-2"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical features at presentation&#58; confluent papulovesicles symmetrically distributed on the extensor surface of the elbows &#40;a and b&#41; were also noted on physical examination&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Gianotti-Crosti Syndrome &#40;GCS&#41; is a reactive&#44; self-limited condition characterized by a symmetrical papular eruption&#44; that occurs primarily in infants and is most commonly associated with viral infections&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Here we report a unique case of an adult patient who developed a skin eruption shortly after vaccination against SARS-CoV-2&#44; with clinical and histopathologic findings supporting the diagnosis of GCS&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 35-year-old woman was referred to our Dermatology clinic for a sudden pruritic papular rash&#46; She reported that the skin lesions first appeared over her buttocks&#44; soon spreading to the upper limbs&#44; palms and trunk&#46; Lesions were moderately itchy&#46; Dermatological examination showed a symmetric eruption with erythematous papules&#44; some of which crusted&#44; 2&#8211;4<span class="elsevierStyleHsp" style=""></span>mm in size&#44; mainly affecting the upper limbs&#44; palms and trunk and scarcely the buttocks &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>a&#8211;c&#41;&#46; In the extensor surface of the elbows&#44; some confluent papulovesicles were observed &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>a and b&#41;&#46; Fever and lymphadenopathy were absent&#46; The patient&#39;s medical history was only remarkable for allergic rhinitis&#46; No history of recent infections or use of oral or topical medication was identified&#46; Ten days prior to the beginning of the eruption&#44; she had received the first dose of SARS-CoV-2 immunization <span class="elsevierStyleItalic">Comirnaty</span>&#174;&#44; a messenger RNA-based vaccine&#46; Histopathological findings&#44; although non-specific&#44; were consistent with those described in GCS &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Symptomatic treatment with antihistamines was prescribed&#46; Complete spontaneous regression of the skin lesions occurred after 12 days&#44; with no scars or altered pigmentation&#46; The second dose of SARS-CoV-2 immunization was administered 21 days after the first one&#44; with no adverse effects reported&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Firstly described by Gianotti and Crosti in the 1950s&#44; GCS is characterized by the acute onset of a symmetrical and monomorphic eruption&#44; with millimetric skin-colored to pink-red flat-topped papules&#44; mainly distributed on the face&#44; buttocks and extensor surfaces of the extremities&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;3</span></a> Palms and soles may also be affected&#46; The trunk is usually spared&#44; although its involvement does not exclude the diagnosis&#46; The lesions can become confluent&#44; mostly over pressure points like knees and elbows and occasionally&#44; may be vesicular&#46; Mild-to-moderate pruritus may be present&#46; Systemic manifestations are unusual and include fever&#44; lymphadenopathy and hepatosplenomegaly&#46; Unusual presentations of GCS have been reported&#44; either by atypical clinical characteristics or location of the skin lesions&#46; Two cases of GCS confined to the face have been reported&#44; as well as a patient with typical GCS lesions accompanied by plantar erythema and desquamation&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">4&#8211;6</span></a> Age&#44; health and vaccination status have been pointed out as potential influencers of clinical presentation&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">GCS primarily affects infants aged between one and six years&#44; rarely occurring in adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#44;2</span></a> Although it usually occurs in association with a viral illness&#44; most often by Hepatitis B virus or Epstein&#8211;Barr virus&#44; it is occasionally associated with other pathogens or vaccinations&#46; The precise pathogenesis of GCS is not clear&#44; but it is presumed to be immunologically mediated&#46; Furthermore&#44; it appears that GCS is associated with atopy&#44; due to its increased prevalence in patients with personal and&#47;or family history of atopic disease&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">3&#44;4</span></a> The diagnosis is mainly clinical&#44; with no characteristic laboratory features nor specific findings in skin biopsy&#46; Patients may have modest lymphocytosis or lymphopenia and liver enzymes may be elevated&#46; Histopathologic findings can include mild epidermal acanthosis and spongiosis with focal paraketatosis&#44; as well as papillary dermis edema and perivascular lymphocytic infiltrate&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The disease has a benign course&#44; with spontaneous resolution usually within 2&#8211;6 weeks&#46; Post-inflammatory hypo- or hyperpigmentation may follow resolution of the skin lesions&#44; but permanent scarring is uncommon&#46; Symptomatic treatment of the associated pruritus usually suffices&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">1&#8211;3</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">We highlight the importance of considering GCS in the differential diagnosis of papular eruptions&#44; even in adult patients&#46; During the current COVID-19 pandemic&#44; the reported cases regarding dermatologic manifestations associated to SARS-CoV-2 have been increasing&#44; some of which concern unexpected groups of patients or clinical contexts&#46; There have been two reported cases of GCS in patients with confirmed COVID-19&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">8&#44;9</span></a> We now report a unique case of this dermatological entity&#44; mainly distributed in atypical locations and associated with SARS-CoV-2 vaccination&#44; so far not described in the literature&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">There are no funding sources of this article&#46;</p></span></span>"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical features at presentation&#58; Erythematous 2&#8211;4<span class="elsevierStyleHsp" style=""></span>mm papules&#44; some of which crusted&#44; localized mainly on the chest &#40;a&#41;&#44; flexor aspect of the right arm &#40;b&#41; and scarcely on the buttocks &#40;c&#41;&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Clinical features at presentation&#58; confluent papulovesicles symmetrically distributed on the extensor surface of the elbows &#40;a and b&#41; were also noted on physical examination&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Histological findings on skin biopsy&#58; patchy spongiosis with focal lichenoid reaction&#44; mild papillary dermal edema and red cell extravasation and a perivascular lymphocytic infiltrate&#59; very rare apoptotic keratinocytes can also be seen&#46;</p>"
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Actas Dermo-Sifiliográficas
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¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?